Is chemotherapy after surgery followed by atezolizumab a good treatment option in patients with early stage non-small-cell lung cancer?

The study aimed to investigate the effectiveness and safety of atezolizumab (Tecentriq) versus best supportive care after chemotherapy in patients with resected early-stage non-small-cell lung cancer (NSCLC). The study showed atezolizumab is effective and has better outcomes than best supportive in these patients. 

NSCLC is the most common form of lung cancer. About 85% of lung cancers are NSCLC. Chemotherapy, radiotherapy, and surgery are the most common treatment option for treating NSCLC. Immunotherapy has emerged as a very good treatment option for metastatic (cancer that has spread away from the original tumor site) NSCLC.

PD-L1 is the protein present on some of the cancer cells. It helps cancer cells evade the immune system and promotes cancer growth. Atezolizumab blocks the PD-L1 protein and helps the immune system to attack the cancer cells. 

Atezolizumab has recently shown promise in advanced stage NSCLC treatment. However, the effectiveness and safety of atezolizumab for patients with early-stage NSCLC who underwent surgery for early-stage cancer followed by platinum-based chemotherapy is not yet known.

The study involved a total of 1005 patients with stage IB-IIIA NSCLC. These patients underwent surgery followed by chemotherapy. After this, patients were randomly assigned to receive either atezolizumab treatment (507 patients) or best supportive care (498 patients). The average follow-up duration was 32.8 months for patients whose tumor expressed PD-L1 on 1% or more tumor cells (group A), and 32.2 months for patients with stage II to IIIA tumors not expressing PD-L1 on cancer cells (group B).

Overall, patients treated with atezolizumab had a 29% better chance of a longer survival without disease. In patients in group A, atezolizumab had a 34% better survival without cancer compared to the best supportive care group. 

After 3 years, 60% of patients treated with atezolizumab in group A were alive and disease-free compared to 48% of patients treated with best supportive care. In all patients, 58% of those treated with atezolizumab and 53% of those treated with best supportive care were alive and disease-free after 3 years. 

Side effects were reported in 93% of patients treated with atezolizumab and 71% of those treated with best supportive care. The most common treatment-related side effects in patients treated with atezolizumab were caught, fever, low thyroid function tests, joint pain, and increased liver enzymes (liver damage).

This study showed that treatment with atezolizumab in patients with early-stage resected NSCLC followed by chemotherapy was associated with improved disease-free survival compared to best supportive care.

This study was supported by F Hoffmann-La Roche and Genentech, the manufacturer of atezolizumab.