Atezolizumab in non-small cell lung cancer – does treatment before surgery improve outcomes?

This study investigated the effect of atezolizumab (Tecentriq) with chemotherapy before surgery in non-small cell lung cancer (NSCLC). They found that this treatment before surgery was safe and effective.   

Non-small cell lung cancer (NSCLC) is the most common form of lung cancer (LC). Treatment depends on the stage of the disease. A combination of surgery and chemotherapy (CT) is the first-line treatment. Radiation therapy (RT) may also be used. The 5-year survival rate is approximately 50%. Aggressive treatment could improve this rate. New targeted therapies may help this. 

Immune checkpoint inhibitors (ICIs) are a newer drug type used in cancer. They target specific receptors or chemicals that tumor cells use to evade the immune system. Atezolizumab is an ICI that targets a chemical called PD-L1. It is approved to treat NSCLC. It is under investigation in a number of other cancers. Most patients have been treated with atezolizumab after chemotherapy. It is unclear if first-line treatment with atezolizumab with chemotherapy before surgery is safe and effective in patients with NSCLC.

This study included 30 patients with NSCLC. These patients had stage 1b – 3a disease. Patients were treated with atezolizumab every three weeks for 4 cycles. CT with nab-paclitaxel (Abraxane) and carboplatin (Paraplatin) was also administered. Patients then underwent surgery to remove tumors. The main outcome was a major pathological response (MPR). MPR was defined as a tumor volume of 10% or less. Patients were followed up for an average of 12.9 months.

Atezolizumab treatment did not delay surgery. 57% of patients had an MPR at 12 months. 33% of patients had a complete response (no tumor). The effect of treatment did not depend on the level of PD-L1 expression.

At follow-up, 63% of patients were alive with no signs of disease.

The most common side effects were reduced white blood cell counts (87%), anemia (77%), fatigue (57%), hair loss (47%), and nausea (43%). 

The authors concluded that atezolizumab combined with CT before surgery was safe and effective in patients with NSCLC.   

The main outcome in this study was MPR. It is unclear if there is any effect of this treatment on survival. Long-term follow-up studies are needed. This study was funded by Genentech and Celgene, the manufacturers of atezolizumab and nab-paclitaxel.