Atezolizumab Combo Improved PFS, OS in Stage IV Non-Small Cell Lung Cancer

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Significant improvements were seen with the addition of atezolizumab to CnP in stage IV non-squamous non-small cell lung cancer, regardless of patient PD-L1 status.
Significant improvements were seen with the addition of atezolizumab to CnP in stage IV non-squamous non-small cell lung cancer, regardless of patient PD-L1 status.
The following article features coverage from the European Society for Medical Oncology (ESMO) 2018 meeting. Click here to read more of Cancer Therapy Advisor's conference coverage.

Adding atezolizumab to carboplatin plus nab-paclitaxel (CnP) as a first-line therapy significantly improved progression-free survival (PFS) and overall survival (OS) in patients with stage IV non-squamous non-small cell lung cancer (NSCLC) compared with treatment with CnP alone, according to the phase 3 IMpower 130 study presented at the 2018 ESMO Congress in Munich, Germany.1

Previous research has shown that atezolizumab alone improved OS compared with docetaxel as second-line treatment in patients with NSCLC. In addition, other first-line studies have shown a clinical benefit for atezolizumab plus chemotherapy.

This phase 3 study tested atezolizumab plus CnP compared with CnP alone in 723 patients with stage IV disease. Patients were randomly assigned 2:1 to receive atezolizumab plus CnP (Arm A) or CnP alone (Arm B) for 4 or 6 21-day cycles and maintenance. Maintenance was treatment with atezolizumab until loss of clinical benefit for patients in arm A and best supportive care or pemetrexed for those who were in arm B.

The intent-to-treat EGFR-wild type ALK-negative population was 679 patients.

Assignment to combination treatment resulted in a clinically meaningful improvement in OS compared with CnP alone. The median OS was 18.6 months for arm A compared with 13.9 months for arm B (hazard ratio [HR] = 0.79; 95% CI, 0.64-0.98; = .033). At 12 months, 63.1% of patients in arm A were alive compared with 55.5% in arm B. 

Similarly, patients assigned to arm A had significant improvements in PFS compared with those in arm B. The median PFS for the atezolizumab plus CnP arm was 7.0 months compared with 5.5 months for the CnP alone arm (HR = 0.64; 95% CI, 0.54-0.77; < .0001).

PFS and OS benefits were observed in all PD-L1 subgroups and was consistent across all subgroups, except patients with liver metastases and EGFR/ALKgenomic alterations.

Median OS for patients assigned to arm A compared with arm B was 17.4 months and 16.9 months for PD-L1–high patients, respectively; 23.7 months compared with 15.9 months for PD-L1–low patients, respectively; and 15.2 months compared with 12.0 months for PD-L1–negative patients, respectively.

Grade 3/4 treatment-related adverse events occurred in 73.2% of patients in arm A compared with 60.3% of patients in arm B.

Disclosure: This study was funded by a pharmaceutical company. For a full list of disclosures, please refer to the original study abstract.

Read more of Cancer Therapy Advisor's coverage of the ESMO 2018 meeting by visiting the conference page.

Reference

  1. Cappuzzo F. Impower130: Progression-free survival (PFS) and safety analysis from a randomized phase 3 study of carboplatin + nab-paclitaxel (CnP) with or without atezolizumab (atezo) as first-line (1L) therapy in advanced non-squamous NSCLC. Abstract presented at: the ESMO 2018 Congress; Munich, Germany: October 19-23, 2018. Abstract LBA53.

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