***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Antibodies that block programmed death 1 ( PD‐1 ) protein improve survival in patients with advanced non – small‐cell lung cancer ( NSCLC ) but have not been tested in resectable NSCLC , a condition in which little progress has been made during the past decade . METHODS In this pilot study , we administered two preoperative doses of PD‐1 inhibitor nivolumab in adults with untreated , surgically resectable early ( stage I , II , or IIIA ) NSCLC .  Nivolumab ( at a dose of 3 mg per kilogram of body weight ) was administered intravenously every 2 weeks , with surgery planned approximately 4 weeks after the first dose . The primary end points of the study were safety and feasibility . We also evaluated the tumor pathological response , expression of programmed death lig and 1 ( PD‐L1 ) , mutational burden , and mutation‐associated , neoantigen‐specific T‐cell responses . RESULTS Neoadjuvant nivolumab had an acceptable side‐effect profile and was not associated with delays in surgery . Of the 21 tumors that were removed , 20 were completely resected . A major pathological response occurred in 9 of 20 resected tumors ( 45 % ) . Responses occurred in both PD‐L1–positive and PD‐L1–negative tumors . There was a significant correlation between the pathological response and the pretreatment tumor mutational burden . The number of T‐cell clones that were found in both the tumor and peripheral blood increased systemically after PD‐1 blockade in eight of nine patients who were evaluated . Mutation‐associated , neoantigen‐specific T‐cell clones from a primary tumor with a complete response on pathological assessment rapidly exp and ed in peripheral blood at 2 to 4 weeks after treatment ; some of these clones were not detected before the administration of nivolumab . CONCLUSIONS Neoadjuvant nivolumab was associated with few side effects , did not delay surgery , and induced a major pathological response in 45 % of resected tumors . The tumor mutational burden was predictive of the pathological response to PD‐1 blockade . Treatment induced expansion of mutation‐associated , neoantigen‐specific T‐cell clones in peripheral blood . ( Funded by Cancer Research Institute – St and Up 2 Cancer and others ; Clinical Trials.gov number , NCT02259621 . BACKGROUND Nivolumab , a fully human IgG4 programmed death 1 ( PD-1 ) immune-checkpoint-inhibitor antibody , disrupts PD-1-mediated signaling and may restore antitumor immunity . METHODS In this r and omized , open-label , international phase 3 study , we assigned patients with nonsquamous non-small-cell lung cancer ( NSCLC ) that had progressed during or after platinum-based doublet chemotherapy  to receive nivolumab at a dose of 3 mg per kilogram of body weight every 2 weeks or docetaxel at a dose of 75 mg per square meter of body-surface area every 3 weeks . The primary end point was overall survival . RESULTS Overall survival was longer with nivolumab than with docetaxel .  The median overall survival was 12.2 months ( 95 % confidence interval [ CI ] , 9.7 to 15.0 ) among 292 patients in the  nivolumab group and 9.4 months ( 95 % CI , 8.1 to 10.7 ) among 290 patients in the docetaxel group ( hazard ratio for death , 0.73 ; 96 % CI , 0.59 to 0.89 ; P=0.002 ) . At 1 year , the overall survival rate was 51 % ( 95 % CI , 45 to 56 ) with nivolumab versus 39 % ( 95 % CI , 33 to 45 ) with docetaxel . With additional follow-up , the overall survival rate at 18 months was 39 % ( 95 % CI , 34 to 45 ) with nivolumab versus 23 % ( 95 % CI , 19 to 28 ) with docetaxel . The response rate was 19 % with nivolumab versus 12 % with docetaxel ( P=0.02 ) . Although progression-free survival did not favor nivolumab over docetaxel ( median , 2.3 months and 4.2 months , respectively ) , the rate of progression-free survival at 1 year was higher with nivolumab than with docetaxel ( 19 % and 8 % , respectively ) . Nivolumab was associated with even greater efficacy  than docetaxel across all end points in subgroups defined according to prespecified levels of tumor-membrane expression ( ≥1 % , ≥5 % , and ≥10 % ) of the PD-1 lig and . Treatment-related adverse events of grade 3 or 4 were reported in 10 % of the patients in the nivolumab group , as compared with 54 % of those in the docetaxel group . CONCLUSIONS Among patients with advanced nonsquamous NSCLC that had progressed during or after platinum-based chemotherapy  , overall survival was longer with nivolumab than with docetaxel . ( Funded by Bristol-Myers Squibb ; CheckMate 057 Clinical Trials.gov number , NCT01673867 . ) BACKGROUND Patients with advanced squamous-cell non-small-cell lung cancer ( NSCLC ) who have disease progression during or after first-line chemotherapy have limited treatment options . This r and omized , open-label , international , phase 3 study evaluated the efficacy and safety of nivolumab , a fully human IgG4 programmed death 1 ( PD-1 ) immune-checkpoint-inhibitor antibody , as compared with docetaxel in this patient population . METHODS We r and omly assigned 272 patients to receive nivolumab , at a dose of 3 mg per kilogram of body weight every 2 weeks , or docetaxel , at a dose of 75 mg per square meter of body-surface area every 3 weeks . The primary end point was overall survival . RESULTS 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 lig and ( 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 . CONCLUSIONS Among patients with advanced , previously treated squamous-cell NSCLC , overall survival , response rate , and progression-free survival were significantly better with nivolumab than with docetaxel , regardless of PD-L1 expression level . ( Funded by Bristol-Myers Squibb ; CheckMate 017 Clinical Trials.gov number , NCT01642004 . ) Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Purpose Nivolumab , a programmed death-1 inhibitor , prolonged overall survival compared with docetaxel in two independent phase III studies in previously treated patients with advanced squamous ( CheckMate 017 ; Clinical Trials.gov identifier : NCT01642004 ) or nonsquamous ( CheckMate 057 ; Clinical Trials.gov identifier : NCT01673867 ) non-small-cell lung cancer ( NSCLC ) . We report up date d results , including a pooled analysis of the two studies . Methods Patients with stage IIIB/IV squamous ( N = 272 ) or nonsquamous ( N = 582 ) NSCLC and disease progression during or after prior platinum-based chemotherapy were r and omly assigned 1:1 to nivolumab ( 3 mg/kg every 2 weeks ) or docetaxel ( 75 mg/m2 every 3 weeks ) . Minimum follow-up for survival was 24.2 months . Results Two-year overall survival rates with nivolumab versus docetaxel were 23 % ( 95 % CI , 16 % to 30 % ) versus 8 % ( 95 % CI , 4 % to 13 % ) in squamous NSCLC and 29 % ( 95 % CI , 24 % to 34 % ) versus 16 % ( 95 % CI , 12 % to 20 % ) in nonsquamous NSCLC ; relative reductions in the risk of death with nivolumab versus docetaxel remained similar to those reported in the primary analyses . Durable responses were observed with nivolumab ; 10 ( 37 % ) of 27 confirmed responders with squamous NSCLC and 19 ( 34 % ) of 56 with nonsquamous NSCLC had ongoing responses after 2 years ' minimum follow-up . No patient in either docetaxel group had an ongoing response . In the pooled analysis , the relative reduction in the risk of death with nivolumab versus docetaxel was 28 % ( hazard ratio , 0.72 ; 95 % CI , 0.62 to 0.84 ) , and rates of treatment-related adverse events were lower with nivolumab than with docetaxel ( any grade , 68 % v 88 % ; grade 3 to 4 , 10 % v 55 % ) . Conclusion Nivolumab provides long-term clinical benefit and a favorable tolerability profile compared with docetaxel in previously treated patients with advanced NSCLC BACKGROUND Patients with squamous non-small-cell lung cancer that is refractory to multiple treatments have poor outcomes . We assessed the activity of nivolumab , a fully human IgG4 PD-1 immune checkpoint inhibitor antibody , for patients with advanced , refractory , squamous non-small-cell lung cancer . METHODS We did this phase 2 , single-arm trial at 27 sites ( academic , hospital , and private cancer centres ) in France , Germany , Italy , and USA . Patients who had received two or more previous treatments received intravenous nivolumab ( 3 mg/kg ) every 2 weeks until progression or unacceptable toxic effects . The primary endpoint was the proportion of patients with a confirmed objective response as assessed by an independent radiology review committee . We included all treated patients in the analyses . This study is registered with Clinical Trials.gov , number NCT01721759 . FINDINGS Between Nov 16 , 2012 , and July 22 , 2013 , we enrolled and treated 117 patients . 17 ( 14·5 % , 95 % CI 8·7 - 22·2 ) of 117 patients had an objective response as assessed by an independent radiology review committee . Median time to response was 3·3 months ( IQR 2·2 - 4·8 ) , and median duration of response was not reached ( 95 % CI 8·31-not applicable ) ; 13 ( 77 % ) of 17 of responses were ongoing at the time of analysis . 30 ( 26 % ) of 117 patients had stable disease ( median duration 6·0 months , 95 % CI 4·7 - 10·9 ) . 20 ( 17 % ) of 117 patients reported grade 3 - 4 treatment-related adverse events , including : fatigue ( five [ 4 % ] of 117 patients ) , pneumonitis ( four [ 3 % ] ) , and diarrhoea ( three [ 3 % ] ) . There were two treatment-associated deaths caused by pneumonia and ischaemic stroke that occurred in patients with multiple comorbidities in the setting of progressive disease . INTERPRETATION Nivolumab has clinical ly meaningful activity and a manageable safety profile in previously treated patients with advanced , refractory , squamous non-small cell lung cancer . These data support the assessment of nivolumab in r and omised , controlled , phase 3 studies of first-line and second-line treatment . FUNDING Bristol-Myers Squibb 
    Output:
    
The anti-tumor efficacy of nivolumab for NSCLC in terms of both PFS and OS was positively correlated with the level of PD-L1 expression .
For advanced NSCLC , nivolumab is a better therapy in terms of both anti-tumor efficacy and safety than docetaxel-based chemotherapy .