Wednesday 20 September 2017 at 10:09
Laura Bagnall: A Nivolumab Story
Laura Bagnall is a busy mum of three who’s living with Stage IV lung cancer.
In fact, she has advanced stage squamous non-small cell lung cancer (NSCLC). About 30% of all cases of NSCLC are of this type. It develops in the flat cells that cover the surface of the airways, and tends to grow near the centre of the lung. It is typically treated with courses of chemotherapy.
Following her diagnosis, Laura received various conventional chemotherapies, including, as a third line, a combination therapy. Eventually, even this third treatment stopped working. Early in 2016 she was told she had just three months to live.
Yet, 18 months later, she’s working, following football with a passion – and, most days, out running as she steps up her training for the London Marathon.
So just how did this dramatic change come about? In a word, nivolumab - a form of immunotherapy. This is the use of drugs that stimulate the body’s immune system to recognise and destroy cancer cells more effectively. It can be used to treat some forms of NSCLC.
For many years, scientists have sought to harness the body’s own immune system to attack cancer cells. But some cancer cells can ‘mask’ themselves from the immune system to prevent it from recognising the threat. Immunotherapy strips away this ‘mask’ to make cancer cells visible to the immune system, so allowing it to attack and destroy them.
The immune system has the ability to stop itself from attacking normal cells in the body. It uses ‘checkpoint molecules’ on immune cells to start an immune response. Cancer cells sometimes ‘mask’ themselves at these checkpoints to avoid being attacked by the immune system.
Nivolumab (known by the brand name Opdivo) targets PD-1, a protein on immune system cells called T-cells. PD-1 normally helps keep these cells from attacking other cells in the body. By blocking PD-1, these drugs boost the immune response against cancer cells. This can shrink some tumours or slow their growth.
For patients like Laura whose options are limited, immunotherapy can offer fresh hope. Tests revealed that her tumours express the ‘right’ kind of protein, indicating she might benefit from nivolumab.
But there was a problem. Last year, the drug was not routinely available as a treatment for lung cancer for NHS patients in England – and Laura lives in West Sussex.
She said: “The only way for me to access it was via EAMS – the Early Access to Medicines Scheme. My oncologist pulled out all the stops and got me onto the scheme. That was the turning point and after three months I was feeling well.
“I thought I’d start running again and the doctors said that would be ok. I started on nivolumab in the March, began running again in June, and I did a half-marathon in October. Immunotherapy was starting to work; my tumours had shrunk considerably. In April this year, I ran the Brighton Marathon. Now, I’ve completed ten half-marathons and a full marathon. I’m now in remission, with no detectable disease. It’s astonishing, I know. You don’t think this really happens – but it does!”