PDQ (Physician Data Query)

PDQ (Physician Data Query) is the National Cancer Institute’s source of comprehensive cancer information. It contains peer-reviewed, evidence-based cancer information summaries on treatment, supportive care, screening, prevention, genetics, and complementary and alternative medicine. The summaries are regularly updated by six editorial boards. The following PDQ summaries were recently updated:

The Stage IV treatment section of the PDQ Non-Small Cell Lung Cancer (NSCLC) Treatment summary was recently updated to include results of two phase II trials that evaluated the addition of necitumumab to platinum doublet chemotherapy in the first-line treatment of patients with advanced non-squamous and advanced squamous NSCLC. In the SQUIRE trial, necitumumab was associated with higher grades 3 and 4 toxicities and a relatively modest benefit; in the INSPIRE trial, serious adverse events and grade 3 and 4 adverse events, including thromboembolic events, were higher in the necitumumab-containing arm; the incidence of treatment-related deaths was also higher.

The Recurrent NSCLC Treatment section of the summary was also recently updated to include nivolumab as a standard treatment option for patients with advanced NSCLC. The summary was updated to include the results of two phase III trials in which nivolumab demonstrated a significant improvement in overall survival compared with the previous standard treatment of docetaxel chemotherapy.

The first of these trials was an open-label phase III trial in which 272 patients with advanced squamous cell NSCLC who had received one regimen of platinum-containing chemotherapy were randomly assigned to receive either nivolumab or docetaxel, administered every 3 weeks until disease progression. The primary endpoint of the trial was overall survival. Nivolumab demonstrated a significant improvement in median overall survival compared with docetaxel, and the objective response rate and median progression-free survival both favored nivolumab. Rates of treatment-related toxicity were significantly lower with nivolumab than with docetaxel.

The second trial was an open-label phase III trial in which 582 patients with advanced non-squamous NSCLC who had received one regimen of platinum containing chemotherapy were randomly assigned to receive either nivolumab or docetaxel, administered every 3 weeks until disease progression. The primary endpoint of the trial was overall survival. Nivolumab demonstrated a significant improvement in median overall survival compared with docetaxel, and the objective response rate favored nivolumab, although the median progression-free survival did not. Rates of treatment-related toxicity were significantly lower with nivolumab than with docetaxel.

Nivolumab is now considered a standard second-line therapy for patients with advanced NSCLC with progression on or after first-line platinum-based chemotherapy and is associated with improved survival and lower rates of toxicity than docetaxel. In addition, the Recurrent NSCLC Treatment section of the summary was updated to include pembrolizumab as an option for patients with metastatic NSCLC whose tumors express PD-L1. Pembrolizumab received accelerated approval from the FDA as a second-line therapy for patients with NSCLC whose tumors express PD-L1 (>50% staining as determined by an FDA-approved test) with progression on or after first-line chemotherapy.

In a phase I study with multiple expansion cohorts, pembrolizumab demonstrated significant activity with respect to response rate and duration of response. In the study, 495 patients received 2mg/kg every 3 weeks, 10mg/kg every 3 weeks, or 10mg/kg every 2 weeks. No significant differences were seen among the different treatment schedules. Median PFS was 3.7 months for all patients, 3.0 months for previously treated patients and 6.0 for previously untreated patients. The median duration of response was 12.5 months in all patients. The most common adverse events were fatigue, pruritus, and decreased appetite. To review the summary, please use the following link:

http://www.cancer.gov/types/lung/hp/non-small-cell-lung-treatment-pdq#section/all

The PDQ Supportive and Palliative Care Board recently completed a comprehensive review of the Cancer Pain summary. The Board conducted a review of the published literature and revised the text and title of the summary and updated the citations. To review the summary, please use the following link:

http://www.cancer.gov/about-cancer/treatment/side-effects/pain/pain-hp-pdq#section/all