Atezolizumab/Cabozantinib vs Docetaxel in Previously Treated Metastatic NSCLC

As reported in the Journal of Clinical Oncology by Joel Neal, MD, PhD, and colleagues, the phase III CONTACT-01 trial has shown no significant improvement in overall survival with the tyrosine kinase inhibitor atezolizumab (multiple targets, including MET, AXL, VEGFR2, RET, and FLT) plus the monoclonal antibody cabozantinib vs docetaxel after checkpoint inhibitor treatment and chemotherapy in patients with metastatic non–small cell lung cancer (NSCLC).¹

Joel Neal, MD, PhD

The open-label trial included 366 patients with metastatic NSCLC and disease progression after concurrent or sequential anti–PD-L1/PD-1 treatment and platinum-containing chemotherapy. They were enrolled from sites in 15 countries between October 2020 and November 2021. Patients were randomly assigned to receive 21-day cycles of atezolizumab at 1,200 mg on day 1 and cabozantinib at 40 mg once daily (n = 186) or docetaxel at 75 mg/m² on day 1 (n = 180). Treatment was continued until disease progression or unacceptable toxicity (or to loss of clinical benefit with atezolizumab/cabozantinib).

Key Findings

At clinical cutoff in September 2022, minimum follow-up was 10.9 months. Median overall survival was 10.7 months (95% confidence interval [CI] = 8.8–12.3 months) in the atezolizumab/cabozantinib group and 10.5 months (95% CI = 8.6–13.0 months) in the docetaxel group (hazard ratio [HR] = 0.88, 95% CI = 0.68–1.16, P = .367). Among patients with available PD-L1 status, median overall survival was 9.5 months vs 9.2 months among 68 vs 70 patients with PD-L1 < 1% (HR = 0.92, 95% CI = 0.61–1.41) and 11.6 months vs 11.1 months among 100 vs 103 patients with PD-L1 ≥ 1% (HR = 0.90, 95% CI = 0.62–1.29). Median progression-free survival was 4.6 months (95% CI = 4.1–5.6 months) in the atezolizumab/cabozantinib group vs 4.0 months (95% CI = 3.1–4.4 months) in the docetaxel group (HR = 0.74, 95% CI = 0.59–0.92).

The most common treatment--related adverse events of any grade were diarrhea, decreased appetite, and palmar-plantar erythrodysesthesia syndrome in the atezolizumab/cabozantinib group, and alopecia and asthenia in the docetaxel group. Grade 3 or 4 treatment-related adverse events occurred in 39.5% vs 34.7% of patients. 

Disclosure: The study was supported by F. Hoffmann–LaRoche Ltd. For full disclosures of the study authors, visit ascopubs.org.

Reference

1. Neal J, Pavlakis N, Kim SW, et al: CONTACT-01. J Clin Oncol. March 29, 2024. Early release online.