Which one is best Duvalumab or the new entrant Keytruda? or perhaps this is a tandem opportunity for us patients?

Steve Holmes
CCF Australia

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The future of cancer success hinges on the power of translation. By deciphering the complex language of cancer genomics into understandable, actionable insights, we unlock a new level of patient engagement, innovation, and survival.” SteveH

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And now there are 2 – FDA Greenlights Keytruda

What’s being targeted?

  • Duvalumab Targets ‘PD-L1’ on the surface of the cell(s), and
  • Keytruda targets ‘PD-1’ on the surface of the T Cells

Understanding the Difference in These 2 Treatment Strategies: Gem/Cis with Durvalumab vs. Keytruda

Cancer treatments can often seem complex, but breaking down these strategies can help us appreciate their ingenious approaches.

The Basics of the Battle:

At the heart of these treatments is the PD-1/PD-L1 checkpoint pathway. T-cells, our immune warriors, have PD-1 checkpoints. They scan for PD-L1 on cells before attacking. If PD-L1 is found, they bind as friends and the attack is ceased, thus allowing the cancer cells to continue growing. Cancer cells cleverly overexpress PD-L1 to evade this attack. The key to these treatments lies in disrupting this sneaky strategy.

  1. Gemcitabine / Cisplatin / Durvalumab (Duva): Gemcitabine and Cisplatin start the fight, targeting and weakening cancer cells directly. Then Durvalumab steps in, blocking numerous PD-L1 receptors on tumor cells. This move exposes the cancer cells, allowing T-cells to continue their attack.
  2. Gemcitabine / Cisplatin / Keytruda (Pembrolizumab): The difference here, Keytruda changes the game. It targets PD-1 on T-cells, effectively releasing the immune system’s brakes, leading to a robust attack on cancer cells.
A Crucial Observation:

The key distinction in these treatments lies in their targets. Durvalumab must block a multitude of PD-L1 receptors, a challenging feat. In contrast, Keytruda focuses on the fewer PD-1 receptors on T-cells, a more straightforward task. This difference in strategy is pivotal in understanding these treatments.

Historical Effectiveness:

Historically, Keytruda has shown increased effectiveness in certain scenarios, thanks to its simpler approach. By focusing on the fewer PD-1 receptors, it efficiently unleashes the immune system. In contrast, Durvalumab faces the daunting task of blocking numerous PD-L1 receptors, which can be a more complex challenge.
Both strategies offer unique approaches, combining direct attacks on cancer cells with advanced immunotherapy. Understanding these differences is crucial in tailoring treatments to individual patient’s needs, advancing our fight against cancer one step at a time