In patients with stage IV squamous non–small cell lung cancer (NSCLC), those with high programmed cell death ligand 1 (PD-L1) expression treated with atezolizumab and chemotherapy experienced longer overall survival rates than those treated with chemotherapy alone. For those participants without high PD-L1
The strong benefit observed in high PD-L1 expressors highlights the relevance of biomarkers for patient selection.— Federico Cappuzzo, MD
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expression, the difference in median overall survival between those who received atezolizumab plus chemotherapy vs chemotherapy alone did not achieve statistical significance. These data from the IMpower131 trial were presented at the International Association for the Study of Lung Cancer (IASLC) 2019 World Conference on Lung Cancer (WCLC).1Federico Cappuzzo, MD, of Azienda Unità Sanitaria Locale della Romagna, presented the study.
IMpower131 is a randomized phase III trial of the PD-L1–targeted immunotherapy atezolizumab plus chemotherapy vs chemotherapy alone as first-line therapy in stage IV squamous NSCLC.
The multicenter trial enrolled 1,021 patients, and participants were randomly assigned to one of three treatment groups. Outcomes for only two of the groups were reported. A total of 343 patients in arm B received atezolizumab/carboplatin/nab-paclitaxel at 100 mg/m2 once a week. A total of 340 patients enrolled in arm C received carboplatin/nab-paclitaxel for four or six cycles, followed by best supportive care. The proportion of patients with high positive or negative PD-L1 expression was similar between the arms.
Robert M. Jotte, MD, PhD
Initial findings from the randomized phase III study were presented at the ASCO 2018 meeting by lead author Robert M. Jotte, MD, PhD, Medical Director and Co-Chair, USON Thoracic Committee, Rocky Mountain Cancer Centers in Denver. Dr. Jotte reported that patients with advanced squamous NSCLC benefited more from initial treatment with atezolizumab and chemotherapy than from chemotherapy alone. A total of 29% of patients who received the combination of atezolizumab and chemotherapy had a reduced risk of disease worsening or death compared with those who received chemotherapy alone. He noted that this benefit was observed across all PD-L1–expressing subgroups.2
Overall Survival Results Reported at ESMO
In the recent report on IMpower 131 presented at the European Society for Medical Oncology (ESMO) Congress 2019, the investigators reported data on overall survival and found that patients in arm B who received atezolizumab plus chemotherapy achieved a median overall survival of 14.2 months vs 13.5 months in arm C, those who received chemotherapy alone. This difference did not cross the boundary for statistical significance.
In the PD-L1–high subgroup, however, the median overall survival was 23.4 vs 10.2 months, respectively, representing a clinically meaningful improvement in the PD-L1–high subgroup, despite not being formally tested.
Treatment-related grade 3 or 4 adverse events and treatment-related adverse effects occurred in 68.0% and 21.0% (arm B) and 57.5% and 10.5% (arm C) of patients; no new safety signals were identified—consistent with previous analyses.
“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 the relevance of biomarkers for patient selection,” said Dr. Cappuzzo in a news release from the World Conference on Lung Cancer. ■
Disclosure: Dr. Cappuzzo has served in a consulting or advisory role with Roche, AstraZeneca, Bristol-Myers Squibb, Pfizer, and Merck Sharp & Dohme. Dr. Jotte has received honoraria; participated on a speakers bureau; and received travel, accommodations, and expenses from Bristol-Myers Squibb.
1. Jotte R, Cappuzzo F, Vynnychenko I, et al: IMpower131: Final overall survival results of carboplatin + nab-paclitaxel +/- atezolizumab in advanced squamous non-small cell lung cancer. 2019 World Lung Cancer Congress. Abstract OA14.03. Presented September 10, 2019.
2. Jotte R, Cappuzzo F, Vynnychenko I, et al: IMpower131: Primary progression-free survival and safety analysis of a randomized phase III study of atezolizumab + carboplatin + nab-paclitaxel vs carboplatin + nab-paclitaxel as first-line therapy in advanced squamous non-small cell lung cancer. ASCO Annual Meeting. Abstract LBA 9000.