Atezolizumab May Improve Survival for Some With Advanced Squamous NSCLC

Patients diagnosed with stage IV squamous non-small cell lung cancer (NSCLC) with high PD-L1 experienced a longer survival rate with atezolizumab (Genentech) plus chemotherapy vs chemotherapy alone based on data from the IMpower131 trial. The data were presented by Dr F. Cappuzzo, from Azienda Unità Sanitaria Locale della Romagna, Ravenna/Italy at the IASLC 2019 World Conference on Lung Cancer.

The multicenter, open-label, phase 3 IMpower 131 trial evaluated the efficacy and safety of atezolizumab + chemotherapy vs chemotherapy alone in chemotherapy-naive patients with stage IV squamous NSCLC (N=1021). Patients were randomized into 3 treatment arms: atezolizumab + carboplatin + paclitaxel (Arm A); atezolizumab + carboplatin + nab-paclitaxel (Arm B); carboplatin + nab-paclitaxel followed by best supportive care (Arm C). The primary end points were progression free survival (PFS), assessed by using RECIST v1.1, and overall survival. 

Results presented at the meeting focused on overall survival, as an improvement in PFS had been previously reported in patients treated with atezolizumab plus carboplatin and nab-paclitaxel. The findings showed the median overall survival in the intention-to-treat population was not statistically significant between Arm B and Arm C (14.2 vs 13.5 months, respectively). However, the median overall survival in the PD-L1-high subgroup demonstrated a clinically meaningful improvement with atezolizumab (23.4 months in Arm B vs 10.2 months in Arm C). 

With regard to safety, grade 3/4 adverse events occurred in 68.0% of patients treated with atezolizumab and chemotherapy vs 57.5% of patients treated with chemotherapy alone.

“The study provides additional evidence on the efficacy of immunotherapy in patients with lung cancer. The strong benefit observed in high PD-L1 expressors highlights relevance of biomarkers for patient selection,” said Dr Cappuzzo.

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Atezolizumab (Tecentriq), a programmed death-ligand 1 (PD-L1) blocking antibody, is currently approved for the treatment of NSCLC, small cell lung cancer, triple-negative breast cancer, and urothelial carcinoma.

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Cappuzzo F, Jotte R, Vynnychenko I, et al. IMpower131: Final OS results of carboplatin + nab-paclitaxel +/- atezolizumab in advanced squamous NSCLC. Presented at: IASLC 2019 World Conference on Lung Cancer hosted by the International Association for the Study of Lung Cancer; September 7-10, 2019; Barcelona, Spain. Abstract OA14.02