Fabrice Barlesi, MD
Keunchil Park, MD
As reported in The Lancet Oncology by Fabrice Barlesi, MD, and colleagues, the phase III JAVELIN Lung 200 trial has shown no overall survival benefit with avelumab vs docetaxel in patients with platinum pretreated programmed cell death ligand 1 (PD-L1)–positive advanced non–small cell lung cancer (NSCLC). Avelumab was associated with fewer severe adverse events. Keunchil Park, MD, of Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, is the corresponding author for The Lancet Oncology article.
In the open-label trial, 792 patients with stage IIIB or IV or recurrent NSCLC and disease progression after treatment with a platinum-containing doublet from 173 sites in 31 countries were randomly assigned between March 2015 and January 2017 to receive the anti–PD-L1 antibody avelumab at 10 mg/kg every 2 weeks (n = 396) or docetaxel at 75 mg/m2every 3 weeks (n = 396). Randomization was stratified by PD-L1 expression. A total of 264 patients treated with avelumab and 265 patients treated with docetaxel with PD-L1–positive tumors (expression ≥ 1%) constituted the primary analysis population.
The primary endpoint was overall survival, analyzed when approximately 337 events had occurred in the PD-L1–positive population. Efficacy was to be subsequently analyzed in the entire randomized population in a hierarchical testing procedure.
Overall Survival and Adverse Events
Median follow-up for overall survival in the PD-L1–positive population was 18.3 months. In the PD-L1–positive population, median overall survival was 11.4 months (95% confidence interval [CI] = 9.4–13.9 months) in the avelumab group vs 10.3 months (95% CI = 8.5–13.0 months) in the docetaxel group (hazard ratio [HR] = 0.90, P = .16). Among all randomized patients, exploratory analysis (due to absence of significance in the primary analysis) showed a median overall survival rate of 10.5 months vs 9.9 months (HR = 0.90, nominal P = .12).
In prespecified exploratory analyses, overall survival was improved with avelumab among 168 avelumab-treated and 147 docetaxel-treated patients with PD-L1 expression ≥ 50% (median 13.6 vs 9.2 months, HR = 0.67, P = .0052) and among 120 and 106 patients with expression ≥ 80% (median = 17.1 vs 9.3 months, HR = 0.59, P = .0022).
Median progression-free survival was 3.4 months for avelu-mab recipients vs 4.1 months for docetaxel recipients (HR = 1.01, nominal P = .53) in the PD-L1–positive population and 2.8 vs 4.2 months in the full population (HR = 1.16, nominal P = .95). After study treatment, 40% of those treated with avelumab and 48% of those treated with docetaxel in the PD-L1–positive population and 40% and 47% in the full population received additional anticancer treatment.
Among all treated patients, treatment-related adverse events of any grade occurred in 64% of the avelumab group vs 86% of the docetaxel group, with grade ≥ 3 adverse events occurring in 10% vs 49%. The most common grade ≥ 3 adverse events were infusion-related reactions (2%) and increased lipase (1%) in the avelumab group, and neutropenia (14%), febrile neutropenia (10%), and decreased neutrophil count (10%) in the docetaxel group. Serious treatment--related adverse events occurred in 9% vs 21% of patients, with the most common in the avelumab group being pneumonitis (1%) and interstitial lung disease (1%). The most common in the docetaxel group were febrile neutropenia (6%), neutropenia (3%), and pneumonia (2%). Treatment-related deaths occurred in 4 patients in the avelumab group (1%) and in 14 patients in the docetaxel group.
The investigators concluded: “Compared with docetaxel, avelu-mab did not improve overall survival in patients with platinum-treated PD-L1–positive NSCLC, but had a favorable safety profile.” ■
