The U.S. Food and Drug Administration today approved nivolumab to treat patients with advanced (metastatic) non-small cell lung cancer whose disease progressed during or after platinum-based chemotherapy.

Lung cancer is the leading cause of cancer death in the United States, with an estimated 221,200 new diagnoses and 158,040 deaths in 2015.

The most common type of lung cancer, non-small cell lung cancer (NSCLC), is further divided into two main types named for the kinds of cells found in the cancer – squamous cell and non-squamous cell (which includes adenocarcinoma).

Opdivo works by targeting the cellular pathway known as PD-1/PD-L1 (proteins found on the body’s immune cells and some cancer cells).

By blocking this pathway, nivolumab may help the body’s immune system fight the cancer cells.

Earlier this year, the FDA approved nivolumab to treat patients with advanced squamous NSCLC whose disease progressed during or after platinum-based chemotherapy.

Today’s approval expands the use of nivolumab to also treat patients with non-squamous NSCLC.

“There is still a lot to learn about the PD-1/PD-L1 pathway and its effects in lung cancer, as well as other tumour types,” said Richard Pazdur, M.D., director of the Office of Haematology and Oncology Products in the FDA’s Center for Drug Evaluation and Research.

“While nivolumab showed an overall survival benefit in certain non-small cell lung cancer patients, it appears that higher expression of PD-L1 in a patient’s tumour predicts those most likely to benefit.”

The safety and effectiveness of nivolumab for this use was demonstrated in an international, open-label, randomised study of 582 participants with advanced NSCLC whose disease progressed during or after treatment with platinum-based chemotherapy and appropriate biologic therapy.

Participants were treated with nivolumab or docetaxel.

The primary endpoint was overall survival, and the secondary endpoint was objective response rate (the percentage of patients who experienced complete or partial shrinkage of their tumours).

Those treated with nivolumab lived an average of 12.2 months compared to 9.4 months in those treated with docetaxel.

Additionally, 19 percent of those treated with nivolumab experienced a complete or partial shrinkage of their tumours, an effect that lasted an average of 17 months, compared to 12 percent among those taking docetaxel, which lasted an average of six months.

While patients who received nivolumab lived longer than those who received docetaxel across the study, an evaluation of samples from a subgroup of patients’ tumours suggests that the level of PD-L1 expression in NSCLC tumours may help identify patients who are more likely to live longer due to treatment with nivolumab.

Therefore, today the FDA also approved the PD-L1 IHC 28-8 pharmDx test to detect PD-L1 protein expression levels and help physicians determine which patients may benefit most from treatment with nivolumab.

The most common side effects of nivolumab are fatigue, musculoskeletal pain, decreased appetite, cough and constipation.

Nivolumab also has the potential to cause serious side effects that result from the immune system effect of nivolumab (known as “immune-mediated side effects”).

These severe immune-mediated side effects involve healthy organs, including the lung, colon, liver, kidneys, hormone-producing glands and the brain. 

The FDA granted nivolumab breakthrough therapy designation for this indication based on preliminary clinical evidence that suggested nivolumab may offer a substantial improvement over available therapies.

It also received priority review status, which is granted to drugs that, at the time the application was submitted, have the potential to be a significant improvement in safety or effectiveness in the treatment of a serious condition.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices.

The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

Source: FDA