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Posted by on Oct 12, 2019 in Lung cancer | 0 comments

In a nutshell

This study investigated if atezolizumab (Tecentriq) combined with chemotherapy (CT) is effective in patients with advanced non-squamous non-small cell lung cancer (NS-NSCLC).

They found that this treatment improved survival in these patients.

Some background

Non-small cell lung cancer (NSCLC) is the most common lung cancer (LC) subtype. NSCLC is categorized as squamous or non-squamous (NS). Standard treatment for NS-NSCLC is chemotherapy (CT). In advanced cancer, CT has a limited effect. New drug targets are needed to improve survival. 

One promising drug type is immune checkpoint inhibitors (ICIs). These drugs restore anti-cancer immunity. Atezolizumab is an ICI. It blocks a protein called PD-L1 from binding to its receptor, PD-1 on immune cells. This allows immune cells to recognize and kill cancer cells. Atezolizumab is used as a second-line treatment for patients with advanced NSCLC. These patients are not responding to CT. Some studies suggest that atezolizumab may improve survival when combined with CT. It is unclear if atezolizumab is an effective first-line treatment in NS-NSCLC. 

Methods & findings

This study included 723 patients with stage 4 NS-NSCLC. Patients were randomly assigned to treatment with atezolizumab + CT or CT only. Atezolizumab was administered every 3 weeks at a dose of 1200mg. The CT drugs administered were carboplatin (Paraplatin) and nab-paclitaxel (Abraxane). Patients that had disease progression were allowed to switch to the atezolizumab + CT group. The main outcomes were overall survival (OS) and progression-free survival (PFS). 

After an average follow-up of 18.5-19.2 months, the average PFS was significantly higher in atezolizumab + CT patients (7 vs. 5.5 months with CT only). OS was significantly higher with atezolizumab + CT treatment (18.6 vs. 13.9 months).

59% of patients in the CT group switched to atezolizumab + CT after disease progression. 7% of patients in the atezolizumab + CT group received additional cancer treatment. 

Side effects were similar between the atezolizumab +CT group and the CT only group (99.6% vs 99.1%). The most common severe side effects were low white blood cell counts (32% with atezolizumab + CT vs 28% with CT) and anemia (low red blood cell counts; 29% with atezolizumab + CT vs 20% with CT). 26% of patients in the atezolizumab + CT group stopped treatment due to side effects. This was compared to 22% of the CT only group.

The bottom line

The authors concluded that atezolizumab improved survival in combination with CT as first-line treatment in patients with advanced NS-NSCLC.

The fine print

This study was funded by  F. Hoffmann-La Roche, the manufacturer of atezolizumab.

Published By :

The Lancet. Oncology

Date :

May 20, 2019

Original Title :

Atezolizumab in combination with carboplatin plus nab-paclitaxel chemotherapy compared with chemotherapy alone as first-line treatment for metastatic non-squamous non-small-cell lung cancer (IMpower130): a multicentre, randomised, open-label, phase 3 tria

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