Perioperative Atezolizumab Plus Chemotherapy Extends EFS in Resectable NSCLC

Perioperative atezolizumab (Tecentriq) plus platinum-based chemotherapy produced a median event-free survival (EFS) of 62.8 months versus 34.9 months with placebo plus chemotherapy in patients with resectable stage IIB to IIIB non–small cell lung cancer (NSCLC) without EGFR or ALK alterations, although the difference did not reach the prespecified threshold for statistical significance, according to final results from the phase 3 IMpower030 trial (NCT03456063) presented at the IASLC 2026 World Conference on Lung Cancer (WCLC).¹

At a median follow-up of 69.3 months in the stage IIB to IIIB wild-type population (n = 397), the independent review facility (IRF)–assessed pathological complete response (pCR) rate was 29.6% with the atezolizumab regimen versus 8.5% with placebo plus chemotherapy, and the IRF-assessed major pathological response (MPR) rate was 53.6% versus 24.4%, respectively.

Investigators reported that investigator-assessed EFS, investigator-assessed disease-free survival (DFS), and overall survival (OS) also favored the atezolizumab arm, and noted that the control arm outperformed historical controls. Surgical cancellation rates were 11.1% with atezolizumab plus chemotherapy vs 10.3% with placebo plus chemotherapy, and no new safety signals were identified.^1,2

"These long-term findings demonstrate clinically meaningful improvements across several important outcomes and further support the role of perioperative immunotherapy for patients with resectable NSCLC," presenting author Benjamin Solomon, MBBS, PhD, a medical oncologist at the Peter MacCallum Cancer Centre, said in a press release issued by the IASLC.²

Rationale for the IMpower030 Trial

Atezolizumab was approved by the US Food and Drug Administration (FDA) in October 2021 as adjuvant treatment following resection and platinum-based chemotherapy for patients with stage II to IIIA NSCLC whose tumors express PD-L1 on at least 1% of tumor cells, based on the phase 3 IMpower010 trial (NCT02486718).³

IMpower030 was designed to determine whether moving the PD-L1 inhibitor into the neoadjuvant phase and continuing it after surgery would improve EFS relative to neoadjuvant chemotherapy alone.¹

The results land in a perioperative NSCLC field with several open questions. Speaking at WCLC 2026, Chris Grant, MD, of the University of California, San Diego, said that direct comparisons of neoadjuvant-only versus full perioperative strategies remain unavailable, that whether patients who achieve a pCR need adjuvant immunotherapy is unresolved, and that circulating tumor DNA is not yet ready to guide these decisions in practice.⁴

How Was the IMpower030 Trial Designed?

The double-blind study enrolled patients with resectable stage II to select stage IIIB NSCLC, an ECOG performance status of 0 or 1, and medical and surgical eligibility for R0 resection. Patients who had received prior therapy for lung cancer or whose tumors harbored activating EGFR mutations or ALK translocations were excluded.¹

Patients were randomly assigned 1:1 to 4 cycles of neoadjuvant atezolizumab at 1200 mg or placebo every 3 weeks plus investigator-selected platinum-based chemotherapy. After surgery, patients in the atezolizumab arm received up to 16 cycles of adjuvant atezolizumab, and those in the placebo arm received best supportive care. The intention-to-treat wild-type population comprised 440 randomized patients; the stage IIB to IIIB wild-type population of 397 patients served as the primary efficacy population.

The primary end point was IRF-assessed EFS in patients with stage IIB to IIIB disease. Key secondary end points included IRF-assessed pCR and MPR, investigator-assessed EFS and DFS, OS, and safety.

Safety Profile of the Perioperative Regimen

Adverse events occurred at higher rates during the neoadjuvant phase than during the adjuvant phase in both treatment arms. Investigators reported that surgical cancellation rates were low and similar between arms and that the safety profile of perioperative atezolizumab was consistent with prior experience, with no new signals identified.^1,2

Investigators concluded that, despite the primary end point falling short of statistical significance, the consistency of improvement across IRF-assessed EFS, investigator-assessed EFS, pCR, MPR, OS, and DFS in this R0-eligible surgical population supports the role of perioperative immunotherapy in resectable NSCLC.¹

References

1. Solomon B, et al. Final analysis of the phase 3 IMpower030 study: perioperative atezolizumab + chemotherapy in resectable stage II-IIIB NSCLC. Presented at: International Association for the Study of Lung Cancer (IASLC) 2026 World Conference on Lung Cancer; September 12-15, 2026; Seoul, South Korea. Abstract 2535.
2. Perioperative atezolizumab plus chemotherapy more than doubles event-free survival in resectable stage II–IIIB NSCLC. News release. International Association for the Study of Lung Cancer. September 12, 2026. Accessed September 13, 2026.
3. FDA approves atezolizumab as adjuvant treatment for non-small cell lung cancer. FDA. October 15, 2021. Accessed September 13, 2026. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-atezolizumab-adjuvant-treatment-non-small-cell-lung-cancer
4. Dr Grant on the Unanswered Questions in Perioperative NSCLC. OncLive. Published September 12, 2026. Accessed September 13, 2026. https://www.onclive.com/view/dr-grant-on-the-unanswered-questions-in-perioperative-nsclc