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What is NSCLC and what can someone with NSCLC expect immediately after diagnosis?McCune: There are two main types of lung cancer, NSCLC and small-cell lung cancer (SCLC), but NSCLC is the most common. About 80% to 85% of lung cancers are NSCLC.
Diagnosing lung cancer can be challenging, as most lung cancers do not cause any symptoms until it has spread. For individuals who do experience lung cancer symptoms, these can include:
- A cough that does not go away or gets worse
- Coughing up blood or rust-colored sputum (spit or phlegm)
- Chest pain that gets worse with deep breathing or coughing
- Loss of appetite
- Unexplained weight loss
- Shortness of breath.
There are several scans and biopsies that can be used to detect lung cancer. Following an advanced NSCLC diagnosis, doctors may also conduct biomarker testing, which typically analyzes a sample of blood, tumor tissue or in some instances, a sample of saliva or skin, to collect specific information about the disease. By performing these tests, doctors can determine the specific genes or proteins in the lung cancer cells, and this information can help guide and personalize treatment decisions.
What does an advanced NSCLC diagnosis mean for patients? How can patients navigate the emotions that can come with this diagnosis?
Rinaldi: An advanced lung cancer diagnosis can be overwhelming for those diagnosed with NSCLC and their loved ones. They may experience fear and shock, which can also prevent them from absorbing information from their doctor at diagnosis and asking questions. For individuals who are newly diagnosed with NSCLC, I advise them to lean on their community for support and to help digest the news. Whether it is a close friend, family member, doctor, or an affiliation with a local patient advocacy group, having a strong support system can be important.
In addition to the illness itself, people may also worry about the potential side effects of treatments. But as they move through treatment, their initial feelings can evolve. Patients often report feeling fearful that their cancer will get worse despite treatment. Individuals with cancer may also worry that their disease will come back later in life.
However, people with NSCLC should know that significant progress has been made in the availability of treatments that can provide hope to the lung cancer community.
How do you work with your patients to decide on a treatment plan?
McCune: When working with people who are newly diagnosed with advanced lung cancer, I conduct the necessary tests to find out the specific type of cancer and any genes or proteins that can help determine the treatment course. As mentioned earlier, biomarker testing is an important step in this process. One protein in particular that we look for is PD-L1, which helps keep the body’s immune response under control and can show if immunotherapy or dual immunotherapy-based treatment options may be an appropriate choice.
I also listen to my patient’s concerns and preferences, and explain their options based on this feedback. For instance, some people that I work with may be wary of chemotherapy, but it’s important to know that it’s an important tool in our toolbox and may be the right choice for certain patients. I try to educate about this.
What are some treatment options available for those newly diagnosed with advanced NSCLC that give you hope as an oncologist?
McCune: There has been tremendous progress in treating advanced NSCLC over the last several years. Today, there are several immunotherapy treatment options available that give me hope as an oncologist. Certain immunotherapy treatment options may be available regardless of whether individuals test PD-L1 positive or negative and, for some patients may be used in combination with chemotherapy. For example, Opdivo® (nivolumab), a prescription medicine used in combination with Yervoy® (ipilimumab) as a first treatment for adults with a type of advanced stage lung cancer (called non-small cell lung cancer) when the individual’s lung cancer has spread to other parts of your body (metastatic) and his/her/their tumors are positive for PD-L1, but do not have an abnormal EGFR or ALK gene.
Opdivo® (nivolumab) is a prescription medicine used in combination with Yervoy® (ipilimumab) and 2 cycles of chemotherapy that contains platinum and another chemotherapy medicine, as a first treatment for adults with a type of advanced stage lung cancer (called non-small cell lung cancer) when the individual’s lung cancer has spread or grown, or comes back, and his/her/their tumor does not have an abnormal EGFR or ALK gene.
Opdivo and Yervoy 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; skin problems; eye problems; problems in other organs and tissues; severe infusion reactions; and complications of stem cell transplant, including graft-versus-host disease (GVHD), that uses donor stem cells (allogeneic). Call or see the healthcare provider right away for any new or worsening signs or symptoms. Please see Important Safety Information below.
What advice do you have for those who are newly diagnosed with advanced NSCLC?
Rinaldi: I recommend they bring a close friend or family member to the appointment if possible. Having someone who can help advocate on their behalf, ask questions, and take notes while they are absorbing the news can help make sure those newly diagnosed don’t miss any information from their doctors. Once they have absorbed the news, I also encourage individuals newly diagnosed with advanced NSCLC to feel empowered to discuss their treatment goals and concerns with their oncologists so they can feel confident in whatever treatment plan they have decided on with their doctor.
There are also other resources available for ongoing support, such as therapy, peer counseling, support groups and educational materials to help them manage their diagnosis, emotionally and physically. Advocacy groups, like the Lung Cancer Research Foundation, can help with connecting patients to these resources.
What questions do you recommend patients ask their oncologist when discussing treatment?
McCune: It’s so important that individuals who are newly diagnosed with NSCLC understand the treatment options that are available to them. This will help them feel informed, which can, in turn, also help them cope with feelings of fear and uncertainty. When discussing a treatment plan with their care team, I recommend asking clarifying questions to help them understand their specific type of cancer and how that will impact the treatment course, such as:
- What type of lung cancer do I have?
- What were the results of my biomarker testing?
- What are my treatment options?
- What type of treatment do you recommend specifically for me and why?
Furthermore, anyone diagnosed with lung cancer should feel empowered to ask about specific treatment options, and discuss the potential benefits and side effects of these options. These questions can include:
- Is dual immunotherapy the right treatment option for me?
- Will I need chemotherapy as part of my treatment plan?
- What are the possible side effects of my treatments and how I can manage them?
These are appropriate questions for caregivers to ask too. By having an open and honest conversation with their oncologist and care team, patients can feel confident that they’re receiving the most optimal care possible and embarking on a treatment path that works best for them.
To learn more about Opdivo + Yervoy, visit www.opdivo.com.
OPDIVO® + YERVOY® will not work for everyone. Individual results may vary.
OPDIVO® (nivolumab) is a prescription medicine used in combination with YERVOY® (ipilimumab) as a first treatment for adults with a type of advanced stage lung cancer (called non-small cell lung cancer) when your lung cancer has spread to other parts of your body (metastatic) and your tumors are positive for PD-L1, but do not have an abnormal EGFR or ALK gene.
OPDIVO® (nivolumab) is a prescription medicine used in combination with YERVOY® (ipilimumab) and 2 cycles of chemotherapy that contains platinum and another chemotherapy medicine, as a first treatment for adults with a type of advanced stage lung cancer (called non-small cell lung cancer) when your lung cancer has spread or grown, or comes back, and your tumor does not have an abnormal EGFR or ALK gene.
It is not known if OPDIVO is safe and effective in children younger than 18 years of age.
Important Safety Information for OPDIVO® (nivolumab) + YERVOY® (ipilimumab)
What is the most important information I should know about OPDIVO + YERVOY?
OPDIVO and YERVOY are medicines that may treat certain cancers by working with your immune system. OPDIVO and YERVOY 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
• Eye problems: blurry vision, double vision, or other vision problems; eye pain or redness.
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 and YERVOY. 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 + YERVOY
OPDIVO and OPDIVO + YERVOY can cause serious side effects, including:
• See “What is the most important information I should know about OPDIVO + YERVOY?”
• Severe infusion reactions. Tell your healthcare team right away if you get these symptoms during an infusion of OPDIVO or YERVOY: chills or shaking; itching or rash; flushing; shortness of breath or wheezing; dizziness; feel like passing out; fever; back or neck pain
• Complications, including graft-versus-host disease (GVHD), 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 or YERVOY. Your healthcare provider will monitor you for these complications.
The most common side effects of OPDIVO, when used in combination with YERVOY, include: feeling tired; diarrhea; rash; itching; nausea; pain in muscles, bones, and joints; fever; cough; decreased appetite; vomiting; stomach-area (abdominal) pain; shortness of breath; upper respiratory tract infection; headache; low thyroid hormone levels (hypothyroidism); constipation; decreased weight; and dizziness.
The most common side effects of OPDIVO, when used in combination with YERVOY and chemotherapy, include: feeling tired; pain in muscles, bones, and joints; nausea; diarrhea; rash; decreased appetite; constipation; and itching.
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 or YERVOY, 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 and YERVOY can harm your unborn baby.
• are breastfeeding or plan to breastfeed. It is not known if OPDIVO or YERVOY passes into your breast milk. Do not breastfeed during treatment with OPDIVO or YERVOY and for 5 months after the last dose of OPDIVO or YERVOY.
Females who are able to become pregnant:
Your healthcare provider should do a pregnancy test before you start receiving OPDIVO or YERVOY.
• You should use an effective method of birth control during your treatment and for at least 5 months after the last dose of OPDIVO or YERVOY. 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 or YERVOY. You or your healthcare provider should contact Bristol-Myers Squibb at 1- 844-593-7869 as soon as you become aware of a pregnancy.
Tell your healthcare provider about all the medicines you take, including prescription and over-the- counter medicines, vitamins, and herbal supplements.
© 2022 Bristol-Myers Squibb Company. OPDIVO®, YERVOY®, and the related logos are registered trademarks of Bristol-Myers Squibb Company. 7356-US-2200297 10/22