Nivolumab

We call it phosphorescence, what we also use for diagnostic.

And then the main procedure now is the development of singlet oxygen, or hydroxy oxygen radicals, which are all used to destroy the malignant cells.

The interesting thing is when we kill tumor cells, we also can kill the blood supplying vessels, which brings the energy and glucose, everything to the tumor.

So we also can damage this.

This was the test is on the left side, about four centimeters.

Yeah.

And then we gave the typical procedure Nivolumab as a PD-1 checkpoint inhibitor intravenously.

We treated with nando inosinin green on two days.

So first is Checkmate 141, which was published in the New England Journal in 2016.

And this was looking at nivolumab, which beat investigator's choice chemotherapy in platinum refractory patients with a median overall survival of about seven and a half to eight months versus five months with a tail of durable responders.

And so this is really the trial that put IO on the map for head and neck cancer.

We also have Keynote 040, which was published in Lancet in 2019.

Additional in-transit metastases, which are metastases that basically are cutaneous deposits between the primary and the nearest sort of drainage lymph node, were allowed if the patient had less than three of them.

Patients had to be naive for anti-PD-1, anti-CTLA-4.

And they were stratified by BRAF status.

Now, what happened is they were randomized to standard of care where they had a total lymph node dissection after resection of the primary and then adjuvant therapy, which is standard of care.

Its maker, Nouveau Nordisk, faces the most exposure of any major drug maker 77 of what made up its 20 000 25 sales is set to lose patent protection by the end of 23. most of it's due to the patent expiration of ozumtic in the early 2030s which generated nearly 20 billion in sales last year patent expiry is a natural part of the pharmaceutical product life signal said nova nordis spokesman said writing that the company is well-equipped to navigate the evolving landscape and accompany loss of exclusivity.

Cancer immunotherapies like Keytruda and rival drug Opdivo are more of some of the major blockbusters.

set to lose patent protection this decade.

This means Merrick, the maker of Keytruda, and Bristol Myers Squibb, which produces Opdivo, have been more than 65% of last year's sales exposed because of these patent expirations along with others.

Keytruda, which is used to treat more than 20 different types of cancer, has generated nearly $32 billion last year, is the best-selling product set to expire before the end of the decade.

Doubled blow.

It was actually an ASCO GU meeting.

But I knew that the FDA was looking at nivolumab for non-small cell lung cancer.

It was going to be the first approval for relapsed disease.

And I remember saying to the audience, wow, things are about to change because, yeah, we've had it for melanoma, but now it's going to be used in lung cancer and we need to get ready for a whole... new world out there, and of course that's what happened, but I remember one of the very first things I was thinking about was just the question you brought up, which is what about people with paraneoplastic syndrome? Do they get worse with IOs? Now we have tarlatumab, and I still, it's almost 10 years later, and I still am not sure I have an answer.