Nivolumab – Pearls of Evidence

PURPOSE: Nivolumab is one of the most extensively studied immune checkpoint inhibitors across various tumor types. In this narrative review, the current clinical efficacy and safety data of anti-programmed death-1 (PD-1) nivolumab for nonsmall cell lung cancer (NSCLC) and renal cell cancer (RCC) are elucidated. METHODS: Systematic search was done on Pubmed, Medline, Embase, Web of Knowledge, and Cochrane Central through September 2016 for controlled prospective interventional studies of nivolumab across two indications - NSCLC and RCC. There was heterogeneity at all levels of abstraction; hence, author did not plan to provide a meta-analysis, but instead, a narrative elaboration of results structured around the conceptual frameworks. RESULTS: Checkpoint receptor PD-1 is a negative regulatory molecule expressed by activated T and B lymphocytes. Binding of PD-1 to its ligands, programmed death-ligands 1 and 2, results in the downregulation of lymphocyte activation. Nivolumab is a fully human PD-1 immune checkpoint inhibitor. Nivolumab inhibits the interaction between PD-1 and its ligands and promotes immune responses including antitumor immune response and antigen-specific T-cell responses to both foreign antigens as well as self-antigens. In 2013, the Food and Drug Administration granted fast track designation for nivolumab in NSCLC, RCC, and melanoma. CONCLUSION: The encouraging literature on nivolumab lends credibility to the promise of immune checkpoint blockade, not just in terms of its feasibility as an oncotherapeutic strategy but also as a key tool of the future in the therapeutic approaches against advanced cancers.