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2016 ; 21
(5
): 634-42
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
FDA Approval Summary: Nivolumab for the Treatment of Metastatic Non-Small Cell
Lung Cancer With Progression On or After Platinum-Based Chemotherapy
#MMPMID26984449
Kazandjian D
; Suzman DL
; Blumenthal G
; Mushti S
; He K
; Libeg M
; Keegan P
; Pazdur R
Oncologist
2016[May]; 21
(5
): 634-42
PMID26984449
show ga
: On October 9, 2015, the U.S. Food and Drug Administration expanded the
nivolumab metastatic non-small cell lung cancer (NSCLC) indication to include
patients with nonsquamous NSCLC after a 3.25-month review timeline. Approval was
based on demonstration of an improvement in overall survival (OS) in an
international, multicenter, open-label, randomized trial comparing nivolumab to
docetaxel in patients with metastatic nonsquamous NSCLC with progression on or
after platinum-based chemotherapy. The CheckMate 057 trial enrolled 582 patients
who were randomized (1:1) to receive nivolumab or docetaxel. Nivolumab
demonstrated improved OS compared with docetaxel at the prespecified interim
analysis with a hazard ratio (HR) of 0.73 (p = .0015), and a median OS of 12.2
months (95% CI: 9.7-15.0 months) in patients treated with nivolumab compared with
9.4 months (95% CI: 8.0-10.7 months) in patients treated with docetaxel. A
statistically significant improvement in objective response rate (ORR) was also
observed, with an ORR of 19% (95% CI: 15%-24%) in the nivolumab arm and 12% (95%
CI: 9%-17%) in the docetaxel arm. The median duration of response was 17 months
in the nivolumab arm and 6 months in the docetaxel arm. Progression-free survival
was not statistically different between arms. A prespecified retrospective
subgroup analysis suggested that patients with programmed cell death ligand
1-negative tumors treated with nivolumab had similar OS to those treated with
docetaxel. The toxicity profile of nivolumab was consistent with the known
immune-mediated adverse event profile except for 1 case of grade 5 limbic
encephalitis, which led to a postmarketing requirement study to better
characterize immune-mediated encephalitis. IMPLICATIONS FOR PRACTICE: Based on
the results from the CheckMate 057 clinical trial, nivolumab represents a new
treatment option for patients requiring second-line treatment for metastatic
non-small cell lung cancer. The role of nivolumab in patients with sensitizing
epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK)
alterations is less clear. Until dedicated studies are performed to better
characterize the role and sequence of programmed cell death 1 (PD-1) therapy,
patients with EGFR or ALK alterations should have progressed on appropriate
targeted therapy before initiating PD-1 inhibitor therapy. Some patients whose
tumors lack programmed cell death ligand 1 (PD-L1) expression also appear to have
durable responses. The U.S. Food and Drug Administration granted approval to
Dako's PD-L1 test, PD-L1 IHC 28-8 pharmDx, which the applicant claimed as a
nonessential complementary diagnostic for nivolumab use.
|*Drug Approval
[MESH]
|Adult
[MESH]
|Aged
[MESH]
|Aged, 80 and over
[MESH]
|Antibodies, Monoclonal/adverse effects/*therapeutic use
[MESH]