Low dose Immunotherapy

Most commonly used immunotherapy drugs include the following PD-1/PD-L1 inhibitors: pembrolizumab (Keytruda), nivolumab (Opdivo), atezolizumab (Tecentriq), durvalumab (Imfinzi), and ipilimumab (Yervoy). These drugs are employed to turn on the immune system against your cancer. There are two significant problems wit the use of these agents:

1. Effectiveness; unfortunately, only about 20% of patients derive significant benefit from these drugs, most of these patients have melanoma or have "microsatellite instability - high."
2. Toxicity; these drugs cannot only turn the immune system against your cancer, these drugs can also cause your immune system to attack your normal tissue.

In our office, we use low dose immunotherapy. While most oncologists will tell you that low doses won't be effective against your cancer, there is a plethora of literature indication otherwise. In a phase I study of Opdivo, using 0.1 mg/kg (about 3% of the 3 mg/kg) every other week showed activity and ability to saturate receptors similarly to higher dosages. This would testify that there is most likely no dose-response correlation and that Opdivo could be administered at doses considerably lower than those currently used without affecting the efficacy, while significantly reducing toxicity.

A study in India found that an ultra-low dose of the immunotherapy drug Opdivo helped people with advanced head and neck cancer live longer. And because the dose is 6% of what's typically used in the United States and Europe, it is potentially more affordable. In the clinical trial, the research team added an ultra-low dose of nivolumab to the standard treatment for head and neck cancer in India. The combination more than doubled the percentage of patients still alive 1 year later compared with the standard treatment alone, according to results published October 20, 2022 in the Journal of Clinical Oncology.

In our office, we combine a PD-1 inhibitor (such as Opdivo or Keytruda) with a CTLA-4 inhibitor called ipilimumab (Yervoy). While oncologists will admit that this combination is more effective than using a PD-1/PD-L1 inhibitor alone, they caution the patients regarding likely toxicity. At the doses used in our office, toxicity is generally minimal to non-existent.

At Advanced Medical Therapeutics, we combine immunogenic chemotherapy with combination low dose immunotherapy.