In a nutshell
This study was conducted to assess the safety and patient reported outcomes (PRO) of the addition of atezolizumab (Tecentriq) to chemotherapy with and without bevacizumab (Avastin) vs bevacizumab plus chemotherapy in the treatment of nonsquamous non-small cell lung cancer (NSCLC). The addition of atezolizumab to a chemotherapy regimen was tolerable with a minimal treatment burden in the treatment of nonsquamous NSCLC.
Some background
NSCLC is a common form of lung cancer. It is responsible for around 85% of all lung cancer cases worldwide. Despite advances in treatments NSCLC has a high mortality rate. Nonsquamous is a type of NSCLC.
Atezolizumab is an immunotherapy. It targets a protein PDL-1 that plays a major role in cancerous cells. Blocking PDL-1 restores the capacity of the immune system to attack and kill cancer cells. Bevacizumab is a targeted therapy. Carboplatin (Paraplatin) and paclitaxel (Taxol) are chemotherapies. Atezolizumab, bevacizumab, caboplatin and paclitaxel (ABCP) has previously shown benefits for patients with nonsquamous NSCLC. However, the safety and tolerability of this combination from a patient perspective, have not been investigated.
Methods & findings
There were 1187 patients with NSCLC in this study. Patients were randomly assigned to one of 3 groups. 400 received atezolizumab, carboplatin, and paclitaxel (ACP). 393 received ABCP. 394 received bevacizumab, carboplatin, and paclitaxel (BCP). Patients completed quality of life questionnaires and were followed up for at least 13.5 months.
A similar number of side effects were reported in all groups. Most side efects were mild to moderate and included hair loss, nausea, tiredness. Bleeding from the nose or in the urine was more commonly reported in the groups that received bevacizumab.
During induction (treatment meant to treat the disease), the occurrence of severe side effects was 28.3% with ACP, 28.5% with ABCP, and 26.4% with BCP. During the maintenance treatment (given to help the main treatment succeed) the risk of serious side effects was 20.0% with ACP, 26.3% with ABCP, and 13.0% with BCP.
More patients in the ABCP group stoped treatment due to side effects (33.8%) compared to the ACP group (13.3%) or BCP group (24.9%). On average,patients did not report any significant worsening of their health or physical functioning from any of the treatment groups.
The bottom line
The authors concluded that ABCP therapy seems to be tolerable compared to ACP and BCP in patients with nonsquamous NSLC.
The fine print
This study was supported by F. Hoffmann-La Roche and Genentech, the manufacturers of atezolizumab and bevacizumab.
Published By :
Journal of clinical oncology
Date :
May 27, 2020
