Sandra Horning, MD
Treatment with the combination of atezolizumab (Tecentriq), bevacizumab (Avastin), carboplatin, and paclitaxel significantly improved overall survival (OS) compared with bevacizumab and chemotherapy alone for patients with advanced nonsquamous non–small cell lung cancer (NSCLC), according to findings from the phase III IMpower150 trial.1
In the investigational arms, atezolizumab was administered at 1200 mg intravenously every 3 weeks and bevacizumab was given at 15 mg/kg. In each arm, carboplatin and paclitaxel were given on day 1 of each cycle for 4 to 6 cycles. In arm A, maintenance therapy was given with atezolizumab alone and in arm B patients received maintenance therapy with the combination of bevacizumab and atezolizumab. In arm C, maintenance was given with bevacizumab alone.
The median age of patients in the trial was 63 years and 60% were previous smokers. Overall, most patients were male and the ECOG performance status was 0 for 39% of patients in arm B and for 43% in arm C. The minimum follow-up at the time of the analysis was 9.5 months. For the interim analysis, the study was only designed to compare arms B and C.
The objective response rate (ORR) in the atezolizumab arm was 64% compared with 48% in the bevacizumab/chemotherapy alone group. PD-L1 expression on immune and tumor cells did not appear to impact efficacy, as those testing negative for the marker still experienced an improvement in PFS with atezolizumab (HR, 0.77; 95% CI, 0.61-0.99). However, there was a 50% reduction in the risk of progression or death with atezolizumab in those testing positive for PD-L1 on immune and tumor cells (IHC1/2/3; HR, 0.50; 95% CI, 0.39-0.64).
In the T-effector signature wild-type population, the addition of atezolizumab reduced the risk of progression or death by 49%. The median PFS was 11.3 months with the PD-L1 inhibitor versus 6.8 months with bevacizumab/chemotherapy alone (HR, 0.51; 95% CI, 0.38-0.68; P
<.0001). The ORR in this group was 69% with atezolizumab compared with 54% without the PD-L1 inhibitor. The 12-month PFS rate was 18% with bevacizumab/chemotherapy and 46% with the addition of atezolizumab.
Each of the agents showed similar toxicity profiles as in previous trials. Serious treatment-related adverse events were observed in 25.4% of patients treated with the atezolizumab regimen compared with 19.3% of those in the control arm. There were no new safety signals or toxicity issues with this combination.
Atezolizumab is currently approved as a treatment for patients with metastatic NSCLC following progression on a platinum-containing regimen, and an FDA-approved targeted therapy for those patients harboring EGFR
abnormalities. For lung cancer, bevacizumab is approved for patients with nonsquamous NSCLC in combination with carboplatin and paclitaxel.
- Phase III IMpower150 Study Showed Genentech’s TECENTRIQ (Atezolizumab) and Avastin (Bevacizumab) Plus Carboplatin and Paclitaxel Helped People With Advanced Lung Cancer Live Longer Compared to Avastin Plus Carboplatin and Paclitaxel. Genentech. Posted March 25, 2018. Accessed March 26, 2018. https://bit.ly/2IUPqG2.
- Reck M. Primary PFS and safety analyses of a randomized Phase III study of carboplatin + paclitaxel +/− bevacizumab, with or without atezolizumab in 1L non-squamous metastatic NSCLC (IMpower150). Annals of Oncology, 2017;28(11). Abstract LBA1_PR.