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New drug for stage 4 lung cancer!!!!!


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Nivolumab versus Docetaxel in Advanced Squamous-Cell Non–Small-Cell Lung Cancer

 

http://www.nejm.org/doi/full/10.1056/NEJMoa1504627

 

The median overall survival was 9.2 months (95% confidence interval [CI], 7.3 to 13.3) with nivolumab versus 6.0 months (95% CI, 5.1 to 7.3) with docetaxel. The risk of death was 41% lower with nivolumab than with docetaxel (hazard ratio, 0.59; 95% CI, 0.44 to 0.79; P<0.001). At 1 year, the overall survival rate was 42% (95% CI, 34 to 50) with nivolumab versus 24% (95% CI, 17 to 31) with docetaxel. The response rate was 20% with nivolumab versus 9% with docetaxel (P=0.008). The median progression-free survival was 3.5 months with nivolumab versus 2.8 months with docetaxel (hazard ratio for death or disease progression, 0.62; 95% CI, 0.47 to 0.81; P<0.001). The expression of the PD-1 ligand (PD-L1) was neither prognostic nor predictive of benefit. Treatment-related adverse events of grade 3 or 4 were reported in 7% of the patients in the nivolumab group as compared with 55% of those in the docetaxel group.

 

There is real improvement in overall survival, but this is a last-ditch drug.  Some pt's want to try everything, even to the end, and I think that's OK.

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You can't always interpret a study in that fashion.  You can have patients who lives are extended many months or years, while some may not gain any increased overall survival.  Take a look at the study.  At 2 year f/u, 25% on nivolumab are still alive while only 10% of patients on the control chemo are still alive.  

 

It's a lot of money, but we live in a capitalistic economy and healthcare is not excluded from that.

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