Atezolizumab plus bevacizumab and chemotherapy prolongs PFS in non-small cell lung cancer

The addition of atezolizumab to first-line treatment with bevacizumab and chemotherapy extended PFS by 38% among individuals with advanced nonsquamous non-small cell lung cancer, according to the agent’s manufacturer.

Atezolizumab (Tecentriq, Genentech) is a monoclonal antibody designed to bind with PD-L1.

The randomized, multicenter, open-label phase 3 IMpower150 study assessed the efficacy and safety of atezolizumab in combination of chemotherapy with or without bevacizumab (Avastin, Genentech) for 1,202 patients with stage IV nonsquamous NSCLC who had not undergone chemotherapy for advanced disease.

Researchers randomly assigned patients 1:1:1 to atezolizumab plus carboplatin and paclitaxel (Arm A); atezolizumab and bevacizumab plus carboplatin and paclitaxel (Arm B), or bevacizumab plus carboplatin and paclitaxel (Arm C).

Patients with ALK or EGFR mutations were excluded from the primary intention-to-treat analysis.

The results — presented at European Society for Medical Oncology Immuno Oncology Congress in Geneva — showed the combination of atezolizumab, bevacizumab and chemotherapy extended PFS by 38% (HR = 0.62; 95% CI, 0.52-0.74) compared with bevacizumab and chemotherapy alone.

Researchers reported a doubling of the 12-month landmark PFS rate (37 vs. 18%) and a higher overall response rate (64% vs. 48%) with the atezolizumab regimen than with bevacizumab and chemotherapy alone.

A subgroup analysis of individuals with T-effector gene signature expression showed the addition of atezolizumab to bevacizumab and chemotherapy increased PFS by 49% (HR = 0.51; 95% CI, 0.38-0.68).

“This Tecentriq study is the first positive phase 3 combination trial that showed a cancer immunotherapy reduced the risk [for] the disease getting worse when used as an initial treatment in a broad group of people with advanced nonsquamous NSCLC,” Sandra Horning, MD, chief medical officer and head of global product development for Genentech, said in a company-issued press release. “The IMpower150 study represents an important advance in lung cancer treatment, and we will submit these results to regulatory authorities around the world to potentially bring a new standard of care to people living with this disease as soon as possible.”

The OS analysis from the comparison between atezolizumab, bevacizumab and chemotherapy vs. bevacizumab and chemotherapy alone is expected in the first half of next year.

The safety of atezolizumab and bevacizumab plus chemotherapy appeared consistent with the known safety profile of each agent alone. Researchers observed no new safety signals with the combination.

The most common side effects reported among patients with NSCLC who receive atezolizumab are fatigue, decreased appetite, shortness of breath, cough, nausea, muscle or bone pain, and constipation.

Researchers observed serious adverse events related to treatment in 25.4% of patients assigned atezolizumab, bevacizumab and chemotherapy compared with 19.3% of those who received bevacizumab plus chemotherapy alone.

The addition of atezolizumab to first-line treatment with bevacizumab and chemotherapy extended PFS by 38% among individuals with advanced nonsquamous non-small cell lung cancer, according to the agent’s manufacturer.

Atezolizumab (Tecentriq, Genentech) is a monoclonal antibody designed to bind with PD-L1.

The randomized, multicenter, open-label phase 3 IMpower150 study assessed the efficacy and safety of atezolizumab in combination of chemotherapy with or without bevacizumab (Avastin, Genentech) for 1,202 patients with stage IV nonsquamous NSCLC who had not undergone chemotherapy for advanced disease.

Researchers randomly assigned patients 1:1:1 to atezolizumab plus carboplatin and paclitaxel (Arm A); atezolizumab and bevacizumab plus carboplatin and paclitaxel (Arm B), or bevacizumab plus carboplatin and paclitaxel (Arm C).

Patients with ALK or EGFR mutations were excluded from the primary intention-to-treat analysis.

The results — presented at European Society for Medical Oncology Immuno Oncology Congress in Geneva — showed the combination of atezolizumab, bevacizumab and chemotherapy extended PFS by 38% (HR = 0.62; 95% CI, 0.52-0.74) compared with bevacizumab and chemotherapy alone.

Researchers reported a doubling of the 12-month landmark PFS rate (37 vs. 18%) and a higher overall response rate (64% vs. 48%) with the atezolizumab regimen than with bevacizumab and chemotherapy alone.

A subgroup analysis of individuals with T-effector gene signature expression showed the addition of atezolizumab to bevacizumab and chemotherapy increased PFS by 49% (HR = 0.51; 95% CI, 0.38-0.68).

“This Tecentriq study is the first positive phase 3 combination trial that showed a cancer immunotherapy reduced the risk [for] the disease getting worse when used as an initial treatment in a broad group of people with advanced nonsquamous NSCLC,” Sandra Horning, MD, chief medical officer and head of global product development for Genentech, said in a company-issued press release. “The IMpower150 study represents an important advance in lung cancer treatment, and we will submit these results to regulatory authorities around the world to potentially bring a new standard of care to people living with this disease as soon as possible.”

The OS analysis from the comparison between atezolizumab, bevacizumab and chemotherapy vs. bevacizumab and chemotherapy alone is expected in the first half of next year.

The safety of atezolizumab and bevacizumab plus chemotherapy appeared consistent with the known safety profile of each agent alone. Researchers observed no new safety signals with the combination.

The most common side effects reported among patients with NSCLC who receive atezolizumab are fatigue, decreased appetite, shortness of breath, cough, nausea, muscle or bone pain, and constipation.

Researchers observed serious adverse events related to treatment in 25.4% of patients assigned atezolizumab, bevacizumab and chemotherapy compared with 19.3% of those who received bevacizumab plus chemotherapy alone.