The fear of cancer recurrence and understanding treatment options

With nearly 2 million Americans expected to have received a cancer diagnosis in 2022 alone, the disease continues to have a far-reaching impact. Historically, the goal of drug development has been to achieve remission, but recently one question has emerged at the forefront of some researchers' minds: How do we help keep cancer from coming back?

An emerging area of research aims to answer this question, and better understand how certain treatments can potentially help reduce the risk of cancer recurrence.

For certain forms of the disease, surgical removal of the tumor may be an option when diagnosed at an earlier stage (also defined as before the cancer has spread to other parts of the body). For some patients, surgery may be enough to prevent cancer from returning, but for others, including those with certain types of melanoma or bladder cancers, there may be an increased risk of cancer coming back. Fortunately, clinical research across earlier stages has brought more options that can be given to patients either before or after surgery, to potentially lower the risk of recurrence for some patients.

“Many associate the challenges of cancer with its physical toll, but there’s another impact that can linger for patients even after treatment is over, and that is a fear of the cancer coming back,” said Elena Jeannotte, vice president of External Relations at the National Coalition for Cancer Survivorship. “Worry about recurrence may become mentally and emotionally draining to both the patient and their loved ones, with every minor ache or discomfort setting off alarm bells and every follow-up scan bringing a new wave of anxiety. This can become a daily struggle, so it’s important that patients feel confident that they’re doing what they can to help keep their cancer at bay.”

Immunotherapy, a type of treatment which uses the body’s immune system to help fight cancer, is one ongoing area of focus in cancer research. In recent years, research to better understand the potential of immunotherapy in earlier stages of cancer has expanded. “This includes examining how certain immunotherapies alone or in combination with other therapies may improve the body’s tumor-fighting immune response either before or after surgery and potentially help reduce the risk of the cancer returning – a principal treatment goal,” said Dr. Lee James, vice president of U.S. Medical Oncology at Bristol Myers Squibb. “And, importantly, we are already seeing innovation come to bear.”

Investigation into the role of immunotherapy in earlier stages of cancer is ongoing, but recent advances have already resulted in more options for certain patients – with multiple immunotherapies approved in both neoadjuvant and adjuvant settings (defined below) for some cancers.

One example is Opdivo^® (nivolumab), an immunotherapy that has been approved by the U.S. Food and Drug Administration (FDA) for the adjuvant or neoadjuvant treatment of certain forms of cancer, including:

• For adults with early-stage non-small cell lung cancer in combination with chemotherapy that contains platinum and another chemotherapy medicine, before surgery
• For people with melanoma completely removed by surgery (adjuvant)
• To help prevent esophageal or gastroesophageal junction cancer from coming back after chemoradiation followed by surgery
• For people who have cancer in the bladder or urinary tract removed by surgery to help prevent it from coming back (adjuvant)

Opdivo can cause problems that can sometimes become serious or life-threatening and can lead to death. Serious side effects may include lung problems; intestinal problems; liver problems; hormone gland problems; kidney problems; and skin problems. Call or see a health care provider right away for any new or worsening signs or symptoms. Please see additional Important Safety Information about side effects for Opdivo below.

“It is encouraging and exciting to see how continued progress is changing what may be possible for certain patients in earlier stages of cancer,” said Jeannotte. “Patients often worry that their cancer will return. Understanding treatment options, and knowing there are options that may help prevent recurrence may help them feel a sense of control over what they’re going through.”

If you or your loved ones are worried about cancer recurrence, talk to your doctor about your concerns and what options may be available. For more information, please visit www.Opdivo.com.

INDICATIONS AND IMPORTANT SAFETY INFORMATION 

OPDIVO^® (nivolumab) is a prescription medicine used to treat adults with a type of skin cancer called melanoma to help prevent melanoma from coming back after it and lymph nodes that contain cancer have been removed by surgery.

OPDIVO^® (nivolumab) is a prescription medicine used in combination with chemotherapy that contains platinum and another chemotherapy medicine, before you have surgery, for adults with early-stage lung cancer (called non-small cell lung cancer).

OPDIVO^® (nivolumab) is a prescription medicine used to treat people with cancer of the lining of the urinary tract (including the bladder, ureters, or renal pelvis) [urothelial carcinoma] to help prevent cancer of the urinary tract from coming back after it was removed by surgery.

OPDIVO^® (nivolumab) is a prescription medicine that may be used to help prevent cancer of the tube that connects your throat to your stomach (esophageal cancer) or cancer where the esophagus joins the stomach (gastroesophageal junction cancer) from coming back after it has been treated with chemoradiation followed by surgery to remove the cancer, but some cancer cells were still present in the removed tumor or lymph nodes.

It is not known if OPDIVO is safe and effective in children younger than 18 years of age.

Important Safety Information for OPDIVO^® (nivolumab)

What is the most important information I should know about OPDIVO?

OPDIVO is a medicine that may treat certain cancers by working with your immune system. OPDIVO can cause your immune system to attack normal organs and tissues in any area of your body and can affect the way they work. These problems can sometimes become severe or life-threatening and can lead to death. These problems may happen anytime during treatment or even after your treatment has ended. You may have more than one of these problems at the same time. Some of these problems may happen more often when OPDIVO is used in combination with another therapy.

Call or see your healthcare provider right away if you develop any new or worse signs or symptoms, including:

• Lung problems: new or worsening cough; shortness of breath; chest pain
• Intestinal problems: diarrhea (loose stools) or more frequent bowel movements than usual; stools that are black, tarry, sticky, or have blood or mucus; severe stomach-area (abdominal) pain or tenderness
• Liver problems: yellowing of your skin or the whites of your eyes; severe nausea or vomiting; pain on the right side of your stomach area (abdomen); dark urine (tea colored); bleeding or bruising more easily than normal
• Hormone gland problems: headaches that will not go away or unusual headaches; eye sensitivity to light; eye problems; rapid heart beat; increased sweating; extreme tiredness; weight gain or weight loss; feeling more hungry or thirsty than usual; urinating more often than usual; hair loss; feeling cold; constipation; your voice gets deeper; dizziness or fainting; changes in mood or behavior, such as decreased sex drive, irritability, or forgetfulness
• Kidney problems: decrease in your amount of urine; blood in your urine; swelling in your ankles; loss of appetite
• Skin problems: rash; itching; skin blistering or peeling; painful sores or ulcers in the mouth or nose, throat, or genital area

Problems can also happen in other organs and tissues. These are not all of the signs and symptoms of immune system problems that can happen with OPDIVO. Call or see your healthcare provider right away for any new or worsening signs or symptoms, which may include:

• Chest pain; irregular heartbeat; shortness of breath; swelling of ankles
• Confusion; sleepiness; memory problems; changes in mood or behavior; stiff neck; balance problems; tingling or numbness of the arms or legs
• Double vision; blurry vision; sensitivity to light; eye pain; changes in eye sight
• Persistent or severe muscle pain or weakness; muscle cramps
• Low red blood cells; bruising

Getting medical help right away may help keep these problems from becoming more serious. Your healthcare team will check you for these problems during treatment and may treat you with corticosteroid or hormone replacement medicines. Your healthcare team may also need to delay or completely stop your treatment if you have severe side effects.

Possible side effects of OPDIVO

OPDIVO can cause serious side effects, including:

• See “What is the most important information I should know about OPDIVO?”
• Severe infusion reactions. Tell your healthcare team right away if you get these symptoms during an infusion of OPDIVO: chills or shaking; itching or rash; flushing; shortness of breath or wheezing; dizziness; feel like passing out; fever; back or neck pain
• Complications of bone marrow (stem cell) transplant that uses donor stem cells (allogeneic). These complications can be severe and can lead to death. These complications may happen if you underwent transplantation either before or after being treated with OPDIVO. Your healthcare provider will monitor you for these complications.

The most common side effects of OPDIVO, when used alone, include: feeling tired; rash; pain in muscles, bones, and joints; itchy skin; diarrhea; nausea; weakness; cough; vomiting; shortness of breath; constipation; decreased appetite; back pain; upper respiratory tract infection; fever; headache; stomach-area (abdominal) pain; and urinary tract infection.

The most common side effects of OPDIVO, when used in combination with chemotherapy, include: nausea, constipation, feeling tired, decreased appetite, and rash.

These are not all the possible side effects. For more information, ask your healthcare provider or pharmacist. You are encouraged to report side effects of prescription drugs to the FDA. Call 1-800-FDA-1088.

Before receiving OPDIVO, tell your healthcare provider about all of your medical conditions, including if you:

• have immune system problems such as Crohn’s disease, ulcerative colitis, or lupus
• have received an organ transplant
• have received or plan to receive a stem cell transplant that uses donor stem cells (allogeneic)
• have received radiation treatment to your chest area in the past and have received other medicines that are like OPDIVO
• have a condition that affects your nervous system, such as myasthenia gravis or Guillain-Barré syndrome
• are pregnant or plan to become pregnant. OPDIVO can harm your unborn baby.
• are breastfeeding or plan to breastfeed. It is not known if OPDIVO passes into your breast milk. Do not breastfeed during treatment with OPDIVO and for 5 months after the last dose of OPDIVO.

Females who are able to become pregnant:

Your healthcare provider should do a pregnancy test before you start receiving OPDIVO.

• You should use an effective method of birth control during your treatment and for at least 5 months after the last dose of OPDIVO. Talk to your healthcare provider about birth control methods that you can use during this time.
• Tell your healthcare provider right away if you become pregnant or think you may be pregnant during treatment with OPDIVO.

Tell your healthcare provider about all the medicines you take, including prescription and over-the- counter medicines, vitamins, and herbal supplements.

Please see U.S. Full Prescribing Information and Medication Guide for OPDIVO.

© 2022 Bristol-Myers Squibb Company. All Rights Reserved.

OPDIVO^® and the related logo are trademarks of Bristol-Myers Squibb Company.

1506-US-2200545 Dec/22

Members of the editorial and news staff of Paste BN Network were not involved in the creation of this content.