Combining immunotherapy to current NSCLC cancer treatment regimes

This study looked at the benefit of adding the immunotherapy drug atezolizumab (Tecentriq) to bevacizumab (Avastin) and chemotherapy. The authors stated that combining atezolizumab to bevacizumab and chemotherapy treatment improved progression free survival and overall survival for patients with advanced non-small-cell lung cancer.  

Traditional lung cancer therapy relies heavily on chemotherapy, sometimes in combination with other treatments.  Angiogenesis inhibitors such as bevacizumab work by blocking a protein involved in the formation of blood vessels (angiogenesis) which would then limit the spread of cancerous cells. A combination of bevacizumab and chemotherapy can be used to treat patients with metastatic non-small-cell lung cancer (NSCLC).

Immunotherapy is a type of cancer treatment that works by activating the body’s immune system to kill tumor cells. Tumor cells avoid being killed by immune cells by having a protein called PD-L1. Immunotherapy drugs such as atezolizumab blocks the interactions of this protein, therefore allowing the immune cells to kill the tumor cells.

It is possible that combining multiple types of treatments could improve prognosis in patients with NSCLC.

This study assessed the effectiveness of adding atezolizumab to the combination of bevacizumab and chemotherapy for treating NSCLC.

The trial included 692 patients with advanced NSCLC. Patients were randomly assigned to one of two groups. 356 patients in the treatment group were treated with atezolizumab, bevacizumab and chemotherapy while 336 patients in the control group were treated with bevacizumab and chemotherapy. The average follow-up was 20 months.

Overall, average progression free survival (PFS, time from beginning trial until disease progression) was 8.3 months for treatment group patients and 6.8 months for control group patients. PFS was 39% longer for treatment group patients compared to control group patients. This improved PFS was highest in patients with high levels of PD-L1. In a subgroup of only patients with high levels of PD-L1, PFS was 61% longer for treatment group patients compared to control group patients. However, even treatment group patients with little or no PD-L1 on average had longer PFS than control group patients.

By the final follow-up, 517 patients had disease progression or had died. Of these, 241 were treatment group patients while 276 were control group patients.

Overall survival (OS, time from beginning trial until death) was 22% longer for treatment group patients compared to control group patients. Average OS for treatment group patients was 19.2 months while average OS for control group patients was 14.7 months.

The rate of side effects was similar in each group.

The authors concluded that adding atezolizumab to bevacizumab and chemotherapy treatment improved PFS and OS in patients with advanced NSCLC.

This study was funded by the manufacturers of atezolizumab.