Advanced Squamous NSCLC: The IMpower131 Study



Mark A. Socinski, MD: I mentioned that 3 years ago, we had our first glance at the potential power of immunotherapy. This was based on CheckMate-017. We saw very impressive survival data for nivolumab versus docetaxel in patients with squamous histology, and now we have some squamous data. Ben, I’m going to ask you to tell us about IMpower131.

Benjamin P. Levy, MD: Well, we’ll learn more. I can tell you what I know so far. There’s obviously a rationale to exploit this in the frontline, as we’ve seen—or as you have mentioned. In the second-line setting, there is a pronounced benefit with single-agent immuno-oncology compared with docetaxel. Squamous cell is a histology that we think has a higher number of mutations or is potentially associated with smoking—a clinical enrichment factor that may predict efficacy to immuno-oncology.

This trial, IMpower131, is a 3-arm trial. It’s a very large study, specifically in squamous cell patients. Arm A is carboplatin/paclitaxel/atezolizumab. Arm B is carboplatin/nab-paclitaxel/atezolizumab. Arm C is carboplatin/nab-paclitaxel. In the analysis between arm B and arm C, in adding atezolizumab to a carboplatin/nab-paclitaxel backbone, I think we’ll see a benefit in progression-free survival. I think we know that so far.

The overall survival will be reported. The response rates will also be reported. It will be very interesting to see that. That will be meaningful, obviously—to see overall survival data. I’m surprised that the progression-free survival difference that’s been reported is 6.3 versus 5.7. This just creates more confusion for me. I would have thought that it would have been a much bigger difference, so we’ll see. It will be very interesting to see what the outcomes for overall survival and response rate are.

Corey J. Langer, MD, FACP: I think the fact that there doesn’t seem to be much numerical difference in the median implies that since the difference is significant, we’re seeing a separation beyond the median. That’s been the trend in many, if not most, of these clinical trials.

I question whether it will be a game changer, unless we see an overall survival benefit. I’m not convinced that the progression-free survival data are sufficient. We have heard—and again, we’ve seen no data—from a press release, at least for the KEYNOTE-407 trial, which is the analogous effort, that carboplatin/paclitaxel, or carboplatin/nab-paclitaxel plus or minus pembrolizumab, supposedly has shown both a progression-free survival and overall survival benefit. As time goes on, when we actually do see an overall survival advantage, I’ll be willing and ready to make that significant change in my practice.

Mark A. Socinski, MD: Yes, we’ll have to see the data on that. We haven’t seen it yet.

Transcript Edited for Clarity

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