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Atezolizumab Versus Other Immunotherapy Options

Benjamin P. Levy, MD
Published Online: Thursday, Apr 06, 2017



Transcript:

Benjamin P. Levy, MD:
The mechanism of action for atezolizumab is a little different. It’s a PD-L1 inhibitor rather than a PD-1 inhibitor, which is what Opdivo (nivolumab) and Keytruda (pembrolizumab) are. There may be some consequences on the toxicities, perhaps a little better tolerated in terms of the autoimmune phenomenon that we’re seeing. My straight answer is, I don’t know if there are really any huge differences between these drugs in terms of their clinical activity. There may be some differences, or nuances in differences, in their toxicities, and also, differences in scheduling.

The nice part about atezolizumab is that you don’t need PD-L1 testing to be done for you to deliver it. Now, a PD-L1 test is probably going to be done, anyway, upfront, but the benefit that we saw with this drug was there—even in the subset of patients that did not have PD-L1 expression. Because of that, I think it’s a reasonable option to consider atezolizumab for patients that are chemorefractory, in which you may not even have PD-L1 testing on, or there wasn’t enough tissue upfront to do it. You’re considering an immunotherapeutic approach that is given every 3 weeks. The data is quite compelling. The survival advantages were pretty robust.

Transcript Edited for Clarity
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Transcript:

Benjamin P. Levy, MD:
The mechanism of action for atezolizumab is a little different. It’s a PD-L1 inhibitor rather than a PD-1 inhibitor, which is what Opdivo (nivolumab) and Keytruda (pembrolizumab) are. There may be some consequences on the toxicities, perhaps a little better tolerated in terms of the autoimmune phenomenon that we’re seeing. My straight answer is, I don’t know if there are really any huge differences between these drugs in terms of their clinical activity. There may be some differences, or nuances in differences, in their toxicities, and also, differences in scheduling.

The nice part about atezolizumab is that you don’t need PD-L1 testing to be done for you to deliver it. Now, a PD-L1 test is probably going to be done, anyway, upfront, but the benefit that we saw with this drug was there—even in the subset of patients that did not have PD-L1 expression. Because of that, I think it’s a reasonable option to consider atezolizumab for patients that are chemorefractory, in which you may not even have PD-L1 testing on, or there wasn’t enough tissue upfront to do it. You’re considering an immunotherapeutic approach that is given every 3 weeks. The data is quite compelling. The survival advantages were pretty robust.

Transcript Edited for Clarity
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