Atezolizumab Combo Improves Survival in Non–Small Cell Lung Cancer

The combination of atezolizumab (Tecentriq), bevacizumab (Avastin), carboplatin, and paclitaxel (ABCP) reduced the risk of death by 22% compared with bevacizumab and chemotherapy (BCP) in patients with advanced wild-type non-squamous non—small cell lung cancer (NSCLC), according to phase III data from the IMpower150 trial presented at the 2018 ASCO Congress and published in the New England Journal of Medicine.^1,2

The median overall survival (OS) with the addition of the PD-L1 inhibitor atezolizumab was 19.2 months (95% CI, 17.0-23.8) compared with 14.7 months (95% CI, 13.3-16.9) in the BCP arm (HR, 0.78; 95% CI, 0.64-0.96; P = .0164). The 24-month OS rate with atezolizumab was 43% compared with 34% for BCP. ABCP also improved median progression-free survival (PFS) by 1.5 months compared with BCP (8.3 vs 6.8 months; HR, 0.59; 95% CI, 0.50-0.70; P <.0001).

"The IMpower150 trial met its co-primary PFS and OS endpoints and demonstrated a statistically significant and clinically meaningful benefit with atezolizumab plus bevacizumab and chemotherapy versus bevacizumab and chemotherapy alone in the first-line nonsquamous NSCLC setting, across all PD-L1 subgroups," said lead investigator Mark A. Socinski, MD, executive medical director of the Florida Hospital Cancer Institute. "In the landmark analysis, you see an approximate doubling in median PFS and a tripling in the 18-month progression-free rate."

The trial was designed to exclude data for patients with EGFR/ALK-mutated NSCLC from the co-primary endpoints of OS and PFS. Approximately 13% of the trials participants were EGFR or ALK-positive. Prior to study entry, these patients had received at least 1 prior EGFR TKI.

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