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IMpower130: Addition of First-Line Atezolizumab to Chemotherapy in Metastatic Nonsquamous NSCLC

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Key Points

  • Median overall survival was 18.6 months in the atezolizumab group vs 13.9 months in the chemotherapy group.
  • Median progression-free survival was 7.0 months vs 5.5 months.
  • A benefit in overall survival and progression-free survival in the atezolizumab group was observed, regardless of programmed cell death ligand 1 expression.

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®.


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