Pharmacy and Wellness Review


The programmed death-1 (PD-1) pathway has a significant role in the promotion of immune tolerance. The PD-1 receptor ligands are normally expressed on various inactive immune cells. When cancer cells express these ligands, they are able to interact with active T and B lymphocytes to induce this tolerance. Nivolumab and pembrolizumab are two recently approved agents that act to disrupt this binding and facilitate an immune response against cancer cells. Numerous trials, including KEYNOTE-002 and CheckMate 063, have demonstrated the superior safety and efficacy of these drugs in patients with advanced or refractory cancers. Initially approved for the treatment of advanced or metastatic melanoma, both nivolumab (Opdivo®) and pembrolizumab (Keytruda®) have recently received expanded indications for the treatment of advanced squamous and non-squamous non-small cell lung cancer (NSCLC). However, both agents were granted accelerated approval and long-term studies evaluating their use are ongoing. Adverse drug events commonly associated with PD-1 inhibitors include fatigue, pruritus, decreased appetite and gastrointestinal disorders. More serious immune-mediated events such as hepatitis, colitis, hypophysitis, nephritis and thyroid disorders may also occur. The cost of therapy with anti-PD-1 drugs can reach upwards of $143,000 to $150,000 per year. Pharmacists should be familiar with current therapeutic recommendations regarding PD-1 targeted therapy. Pharmacists may also counsel patients on how to monitor for adverse reactions and common side effects associated with these medications.



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