The safety and effectiveness of atezolizumab in PD-L1 advanced non-small cell lung cancer

This trial looked at the effectiveness and safety of an immunotherapy drug, atezolizumab (Tecentriq). The authors concluded that this drug is effective and safe to treat patients with advanced non-small-cell lung cancer who have high levels of the PD-L1 protein.

Immunotherapy is a fairly new type of cancer treatment. It 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 blocks the interactions of this protein, therefore allowing the immune cells to kill the tumor cells. Atezolizumab (Tecentriq) is a PD-L1 blocker. Whether atezolizumab is more effective for certain types of non-small cell lung cancer (NSCLC) remains unknown.

This trial looked at whether atezolizumab was effective at treating cancer in patients with advanced non-small-cell lung cancer (NSCLC) who had the PD-L1 protein.

A total of 659 patients were included in this trial. Group 1 had 139 patients who were previously untreated. Group 2 had 268 patients who were on their second line of treatment. Group 3 had 252 patients who were on their third line of treatment. The researchers looked at objective response rate (ORR, the percent of patients with a response such as decrease in tumor size). Patients were followed for at least 12 months.

ORR for group 1 patients was 22%, 19% for group 2 and 18% for group 3. Of the patients with a high amount of PD-L1 protein, the ORR was 31% for group 1, 26% for group 2 and 27% for group 3.

Progression free survival (time from beginning trial until disease progression) was longer for group 1 patients at an average of 5.4 months, compared to 2.8 months for both group 2 and 3 patients.

Overall survival (OS, time from beginning trial until death) was also longer for group 1 patients at 23.5 months, compared to 15.5 months for group 2 and 13.2 months for group 3 patients. Furthermore, for patients with a high amount of PD-L1, OS was 26.9 months for group 1 patients.

94% of patients experienced side effects. 42% of patients experienced grade 3 or 4 (serious or severe) side effects. The most common side effects were fatigue, diarrhea, nausea and itching. The most common severe side effects were pneumonia, labored breathing, fever and inflammation in the lungs. 1% of patients died due to pneumonia.

The authors concluded that atezolizumab can be an effective and relatively safe treatment for patients with advanced NSCLC, particularly those who have more PD-L1 protein. They suggest that the presence of PD-L1 could therefore be used to predict the type of treatment a patient receives.

This trial was funded in part by Genentech, the manufacturers of atezolizumab.