Share with Colleagues
Previous EBM Focus Issues
DynaMed Free Trial
Send Comment to Editor
Physicians: .25 AMA PRA Category I CreditsTM
Family Physicians: .25 Prescribed credits
Nurse Practitioners: .25 Contact hours
Release Date: June 17, 2015
Expiration Date: June 17, 2016
Estimated Completion Time: 15 minutes
There is no fee for this activity.
To Receive Credit
In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon above.
Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.
Alan Ehrlich, MD
Assistant Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Executive Deputy Editor, DynaMed, Ipswich, Massachusetts, USA
Michael Fleming, MD, FAAFP
Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company
Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.
No commercial support has been received for this activity.
ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.
AAFP: This enduring material activity, DynaMed EBM Focus Volume 10+, has been reviewed and is acceptable for up to 13.25 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins April 29, 2015. Term of approval is for one year from this date. Each weekly update is approved for .25 Prescribed credits. Credit may be claimed for one year from the date of each update. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
AANP: This program is approved for 13.0 contact hour(s) of continuing education by the American Association of Nurse Practitioners. Program ID 1504207. This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standards.
The DynaMed editorial team is seeking specialist editors in the following fields: Gastroenterology, Nephrology, Oncology (especially Breast cancer and Pancreatic cancer), Ophthalmology, and Pediatric Neurology.
If interested, please send a recent copy of your CV to Rachel Brady at firstname.lastname@example.org.
DynaMed Contribution Opportunities
Become a DynaMed Resident Focus Reviewer
Education for Clinicians in Training
Last week 585 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 178 articles were added to DynaMed content.
Based on criteria for selecting "articles most likely to inform clinical practice," one article was selected by the DynaMed Editorial Team.
Nivolumab May Increase Overall Survival and Progression-Free Survival Compared to Docetaxel in Patients with Advanced Squamous Cell Non-Small Cell Lung Cancer
Reference: N Engl J Med 2015 May 31 early online (level 2 [mid-level] evidence)
Programmed death 1 (PD-1) receptors on activated T cells interact with PD-1 ligands expressed on tumor cells, suppressing immune activation and promoting tumor immune evasion (Curr Opin Pharmacol 2015 Jun 1;23:32). Anti-PD-1 antibodies have been shown to improve survival compared to chemotherapeutic agents in patients with not previously treated advanced melanoma and relapsed or refractory Hodgkin lymphoma (N Engl J Med 2015 Jan 22;372(4):320, N Engl J Med 2015 Jan 22;372(4):311). Although docetaxel is currently recommended for patients with squamous cell non-small cell lung cancer with progression after first-line therapy (Chest. 2013 May;143(5 Suppl):e341S-68S, NCCN 2014 Jun), recent evidence suggests anti-PD1 antibodies may be effective in this patient population as well. The anti-PD-1 antibody nivolumab has previously been shown to produce an objective response in 14.5% of patients with advanced squamous cell non-small cell lung cancer and ≥ 2 previous treatments, with an additional 26% of patients experiencing stable disease during this phase 2 study (Lancet Oncol 2015 Mar;16(3):257). A recent randomized trial compared nivolumab 3 mg/kg IV every 2 weeks vs. docetaxel 75 mg/m2 IV every 3 weeks in 272 patients with advanced squamous cell non-small cell lung cancer experiencing disease recurrence after treatment with platinum-containing regimens. All patients had stage IIIB or stage IV disease and an Eastern Cooperative Oncology Group performance-status score of 0-1. Patients were treated until disease progression or discontinuation due to adverse events (or other reasons).
Nivolumab was associated with increased overall survival with a median survival of 9.2 months compared to 6 months with docetaxel (p < 0.001). The overall survival rate at 1 year was 42% in patients treated with nivolumab and 24% in patients treated with docetaxel (p < 0.001, NNT 6). Nivolumab was also associated with increased median progression-free survival (3.5 months vs. 2.8 month, p < 0.001) and an increased rate of patients experiencing a confirmed objective tumor response (20% vs. 9%, p = 0.008, NNT 9). Any adverse event was reported in 58% with nivolumab vs. 86% with docetaxel (no p value reported), and grade 3 or 4 adverse events were reported in 7% with nivolumab vs. 55% with docetaxel (no p value reported). PD-1 ligand expression in pretreatment tumor samples was not associated with nivolumab efficacy.
Compared to standard docetaxel therapy, nivolumab increased median overall survival by > 3 months, with nearly twice as many patients surviving 1 year after treatment initiation. The rate of progression-free survival at 1 year was also more than 3 times greater with nivolumab compared to docetaxel and significantly more patients had a complete or partial tumor response. Not only was nivolumab more effective than docetaxel, but it also had a better safety profile, with a drastic reduction in the number of serious adverse events reported in the nivolumab group. Tumor PD-1 ligand expression did not predict patient response, suggesting nivolumab effectiveness may not be limited to patients with high pre-treatment levels of PD-1 ligand. The results of this trial suggest that nivolumab may not only be more effective than docetaxel as a second-line therapy in patients with advanced squamous cell non-small cell lung cancer, but it may also be safer. These results combined with previous data have led the FDA to approve nivolumab for patients with metastatic squamous cell non-small cell lung cancer with progression on or after platinum-based chemotherapy.
For more information see the Management of metastatic non-small cell lung cancer topic in DynaMed.
EBSCO Health’s New DynaMed Plus Delivers Trusted, Evidence-Based Content to Physicians on Any Platform
EBSCO Health recently launched DynaMed Plus, a cross-platform, evidence-based clinical decision support tool that provides clinicians with the ideal blend of evidence and expertise to help them determine optimal patient care paths.
DynaMed Plus helps medical professionals quickly find evidence-based answers to make the best treatment decisions in any location. With DynaMed Plus, clinicians (and their patients) will benefit from:
- Quickest time-to-answer—Including intelligent auto-suggest, direct-to-section search results, exact match summary display, dynamic linking and quick access to relevant calculators.
- Concise, accurate overviews and recommendations—For the most common conditions as well as evidence-based recommendations for action.
- Comprehensive image library—Over 4,000 full-color medical graphics and images to help clinicians make the best decisions.
- Rigorous editorial process—Subject-specific experts review topics on a daily basis using the DynaMed Plus proprietary evidence-based methodology and quality assurance process.
- Access to specialty content—Clinicians can view thousands of topics covering emergency medicine, cardiology, oncology, infectious disease, pediatrics, obstetrics and gynecology, and much more.
- Anywhere, anytime access—DynaMed Plus can be used on iOS and Android mobile devices, making access fast and easy, and providing clinicians with an intuitive and elegant mobile experience.
To read the press release and for more information on DynaMed Plus, click here. For free trial information, click here.
Critical Appraisal of the Medical Literature: A Simplified Approach
July 8 – 9, 2015 – Portland State University - Portland, Oregon.
Join our Editorial Board members Sheri Strite and Michael Stuart and improve your critical appraisal skills. We aim to make critical appraisal of the medical literature meaningful, useful, simple, and doable. This program will be particularly helpful to those who routinely evaluate the medical literature.
Visit the Seminar page for more details.