ESMO 2019 — Atezolizumab monotherapy is a promising first-line treatment in PD-L1–selected NSCLC

Why this matters

• Tumour PD-L1 level and tumour histology are now used to determine treatment regimens in mNSCLC.
• PD-L1/PD-1 inhibitor (CPI) monotherapy remains an attractive choice for patients ineligible for the immuno-chemotherapy combination.

Study design

• 572 chemo-naïve patients with stage IV nonsquamous (nsq) or squamous (sq) NSCLC were enrolled in phase 3 IMpower110 study.
• Patients received atezolizumab 1200 mg intravenous (IV) q3w (Arm A) or platinum-based chemo (Arm B; 4 to 6 21-day cycles).
• Chemotherapy was cisplatin/carboplatin + pemetrexed for nsq patients and cisplatin/carboplatin + gemcitabine for sq patients.
• Primary endpoint: OS.
• Key secondary endpoints included progression-free survival (PFS), objective response rate (ORR), and duration of response (DOR). 
• Funding: F. Hoffmann-La Roche.

Key results

• The 3 primary efficacy populations included 554, 328, and 205 patients with TC1/2/3 or IC1/2/3 WT, TC2/3 or IC2/3 WT and 205 TC3 or IC3 WT disease, respectively.
• In the TC3 or IC3 WT population, atezolizumab monotherapy improved median OS by 7.1 months (HR 0.595; P=0.0106) vs chemotherapy.
• In the same population, atezolizumab also showed meaningful improvements in PFS, ORR, and DOR vs chemotherapy.
• Treatment-related AEs (TRAEs) occurred in 60.5% of patients in atezolizumab group and 85.2% in the chemotherapy group.

Expert commentary

• “Atezolizumab in IC3/TC3 first-line NSCLC could represent a new standard of care in addition to pembrolizumab in PD-L1 positive tumours,” said Naiyer Rizvi, Director of Thoracic Oncology and Immunotherapeutics, Columbia University Medical Center, New York, USA, who was not involved in the study.