The addition of atezolizumab to carboplatin plus etoposide in the first-line setting does not appear to lead to worse health-related quality of life (HRQoL) for patients with extensive-stage small-cell lung cancer (ES-SCLC), according to data from the phase 1/3 IMpower133 trial (ClinicalTrials.gov Identifier: NCT02763579). The trial findings were recently published in the Annals of Oncology.
The trial randomized 403 patients with untreated ES-SCLC to receive atezolizumab, carboplatin, and etoposide (201 patients) or placebo, carboplatin, and etoposide (202 patients).
Patient-reported outcomes (PROs) were collected using 2 European Organisation for Research and Treatment of Cancer (EORTC) instruments: the Quality of Life Questionnaire – Core 30 (QLQ-C30) version 37 and QLQ-LC13, which is the supplemental lung cancer module. Patients completed these assessments at baseline, on day 1 of each 21-day treatment cycle, and 3 months and 6 months after stopping treatment.
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A previous readout of the trial showed that patients on the atezolizumab arm lived a median of 2 months longer than patients on the placebo arm (10.3 vs 12.3 months; hazard ratio, 0.7; 95% CI, 0.54-0.91; P =.007).
The current analysis showed a higher incidence of immune-related adverse events for the atezolizumab arm compared with the placebo arm during the induction phase (28% vs 17%, respectively) and maintenance phase (26% vs 15%, respectively). Also, the atezolizumab arm had a higher incidence of immune-related adverse events leading to dose interruption (9% vs 5%, respectively) or withdrawal (4% vs 0%, respectively) during the induction phase compared with the placebo arm.
The incidence of nausea, vomiting, diarrhea, constipation, decreased appetite, and dyspnea was similar between treatment arms during both the induction and maintenance phases.
Compared with baseline through week 54, both treatment arms had similar trends in improvement for several treatment-related symptoms, including nausea/vomiting, fatigue, dysphagia, insomnia, and appetite loss.
The treatment arms did have differences, however. The placebo arm had more improvement in constipation after week 12. The atezolizumab arm had consistently improved fatigue at every visit through week 54; the placebo arm had improved fatigue at 13 of 18 visits through week 54.
“These analyses show that addition of atezolizumab to standard chemotherapy, which improves both OS and PFS in IMpower133 with comparable safety, does not significantly increase overall treatment burden,” the study authors concluded.
Disclosure: This study and the analyses presented here were funded by F. Hoffmann-La Roche Ltd., and some of the authors disclosed financial relationships with pharmaceutical and medical device companies. For a full list of disclosures, please refer to the original study.
Reference
Mansfield AS, Każarnowicz A, Karaseva N, et al. Safety and patient-reported outcomes of atezolizumab, carboplatin, and etoposide in extensive-stage SCLC (IMpower133): A randomized phase I/III trial. Ann Oncol. 2020;31(2):310-317.
