IMpower130: Addition of First-Line Atezolizumab to Chemotherapy in Metastatic Nonsquamous NSCLC
As reported in The Lancet Oncology by West et al, the phase III IMpower130 trial found that the addition of atezolizumab to carboplatin plus nab-paclitaxel significantly improved overall and progression-free survival in first-line treatment of stage IV nonsquamous non–small cell lung cancer (NSCLC) with no ALK or EGFR mutations.
Study Details
The open-label trial included 724 patients with no previous treatment for stage IV disease from 131 sites in eight countries. Patients were randomly assigned 2:1 between April 2015 and February 2017 to receive atezolizumab 1,200 mg every 3 weeks plus chemotherapy with carboplatin (area under the curve = 6 mg/mL per min every 3 weeks) plus nab-paclitaxel (100 mg/m² every week) or carboplatin plus nab-paclitaxel alone for four or six 21-day cycles followed by maintenance therapy. The intention-to-treat population comprised 483 patients in the atezolizumab plus chemotherapy group and 240 patients in the chemotherapy group. The intention-to-treat wild-type population comprised 451 patients in the atezolizumab plus chemotherapy group and 228 patients in the chemotherapy group. Co-primary endpoints were investigator-assessed progression-free and overall survival in the intention-to-treat wild-type population.
Results
Median follow-up was 18.5 months in the atezolizumab wild-type population and 19.2 months in the chemotherapy wild-type population.
Median overall survival was 18.6 months in the atezolizumab group vs 13.9 months in the chemotherapy group (stratified hazard ratio [HR] = 0.79, P = .033). Median progression-free survival was 7.0 months vs 5.5 months (stratified HR = 0.64, P < .0001). A benefit in overall survival and progression-free survival in the atezolizumab group was observed, regardless of programmed cell death ligand 1 expression.
Among all patients, the most common grade ≥ 3 treatment-related adverse events were neutropenia (32% in atezolizumab group vs 28% in the chemotherapy group), anemia (29% vs 20%), and decreased neutrophil count (12% vs 8%). Treatment-related serious adverse events were reported 24% vs 13% of patients. Treatment-related (any treatment) deaths occurred in 8 (2%) of 473 patients in the atezolizumab plus chemotherapy group and 1 (< 1%) of 232 patients in the chemotherapy group.
The authors concluded, “IMpower130 showed a significant and clinically meaningful improvement in overall survival and a significant improvement in progression-free survival with atezolizumab plus chemotherapy versus chemotherapy as first-line treatment of patients with stage IV nonsquamous NSCLC and no ALK or EGFR mutations.”
Disclosure: This study received funding from F. Hoffmann-La Roche. For full disclosures of the study authors, visit thelancet.com.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
