Assessment of nivolumab benefit-risk profile of a 240-mg flat dose relative to a 3-mg/kg dosing regimen in patients with advanced tumors

Background

Nivolumab 3 mg/kg every 2 weeks (Q2W) has shown benefit versus the standard of care in melanoma, non-small cell lung cancer (NSCLC), and renal cell carcinoma (RCC). However, flat dosing is expected to shorten preparation time and improve ease of administration. With knowledge of nivolumab safety, efficacy, and pharmacokinetics across a wide dose range in body weight (BW) dosing, assessment of the benefit–risk profile of a 240-mg flat dose relative to the approved 3-mg/kg dose was approached by quantitative clinical pharmacology.

Patients and methods

A flat dose of 240 mg was selected based on its equivalence to the 3-mg/kg dose at the median BW of ∼80 kg in patients in the nivolumab program. The benefit–risk profile of nivolumab 240 mg was evaluated by comparing exposures at 3 mg/kg Q2W and 240 mg Q2W across BW and tumor types; clinical safety at 3 mg/kg Q2W by BW and exposure quartiles in melanoma, NSCLC, and RCC; and safety and efficacy at 240 mg Q2W relative to 3 mg/kg Q2W in melanoma, NSCLC, and RCC.

Results

The median nivolumab exposure and its distribution at 240 mg Q2W were similar to 3 mg/kg Q2W in the simulated population. Safety analyses did not demonstrate a clinically meaningful relationship between BW or nivolumab exposure quartiles and frequency or severity of adverse events. The predicted safety and efficacy were similar across nivolumab exposure ranges achieved with 3 mg/kg Q2W or 240 mg Q2W flat dose.

Conclusion

Based on population pharmacokinetic modeling, established flat exposure–response relationships for efficacy and safety, and clinical safety, the benefit–risk profile of nivolumab 240 mg Q2W was comparable to 3 mg/kg Q2W. The quantitative clinical pharmacology approach provided evidence for regulatory decision-making on dose modification, obviating the need for an independent clinical study.

Spectroscopy of magnetic excitations in magnetic superconductors using vortex motion

In magnetic superconductors a moving vortex lattice is accompanied by an ac magnetic field which leads to the generation of spin waves. At resonance conditions the dynamics of vortices in magnetic superconductors changes drastically, resulting in strong peaks in the dc I-V characteristics at voltages at which the washboard frequency of the vortex lattice matches the spin wave frequency omegaS(g), where g are the reciprocal vortex lattice vectors. We show that if the washboard frequency lies above the magnetic gap, measurement of the I-V characteristics provides a new method to obtain information on the spectrum of magnetic excitations in borocarbides and cuprate layered magnetic superconductors.

Nondemolition measurements of a single quantum spin using Josephson oscillations

We consider a single localized spin-1/2 between the singlet superconducting leads of a Josephson junction (e.g., a superconducting STM). For the spin subject to a dc magnetic field B parallel z, we study the spin dynamics and the possibility to measure the spin state via transport through the junction embedded in a dissipative circuit. Turning on the tunneling or a voltage bias induces oscillations of the Josephson current, with an amplitude sensitive to the initial value of the z component of the spin, S(z)=+/-1/2. At low temperatures, when effects of quasiparticles are negligible, this procedure realizes a quantum nondemolition measurement of S(z).