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Atezolizumab provides long-term lung cancer survival benefit
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Atezolizumab improved 3-year OS compared with docetaxel among patients with advanced non-small cell lung cancer, according to findings from the phase 2 randomized controlled POPLAR trial presented at the European Lung Cancer Congress.
“Nearly one in five patients treated with atezolizumab [Tecentriq, Genentech] was alive at 3 years,” Julien Maziéres, MD, PhD, professor of medicine at Toulouse University Hospital in France, said in a press release. “This places atezolizumab among the drugs with the highest landmark OS in previously treated lung patients.”
Researchers randomly assigned 287 patients with advanced NSCLC from 61 sites in 13 countries 1:1 to receive 1,200 mg atezolizumab or 75 mg/m2 docetaxel every 3 weeks.
Maziéres and colleagues prospectively evaluated patients for tumor cell (TC) or tumor-infiltrating immune cell (IC) PD-L1 expression and used the Kaplan-Meier method to estimate landmark OS.
Minimum follow-up was 3 years.
More patients in the atezolizumab group achieved 2-year OS (32.2% vs. 16.6%; P = .0027) and 3-year OS (18.7% vs. 10%; P = .0419) than the docetaxel group.
This long-term benefit occurred across PD-L1 expression subgroups — although improvement appeared strongest in the TC3 or IC3 subgroups (2-year OS, 41.7% vs. 19.9%; 3-year OS, 37.5% vs. 14.9%) — and for both squamous (2-year OS, 32.7% vs. 7.8%; P = .002; 3-year OS, 9.4% vs. 5.2%) and nonsquamous histology (2-year OS, 32.2% vs. 21.1%; 3-year OS, 23.3% vs. 12.4%).
However, even patients in the TC0 and IC0 groups showed better survival with atezolizumab at 2 years (25% vs. 6.8%; P = .0202) and 3 years (20.5% vs. 6.8%).
“The fact that all subgroups of patients benefitted to a similar degree is good in the sense that atezolizumab can be tried in all advanced NSCLC patients,” Maziéres said in the release. “On the other hand, it means that we cannot predict which patients are most likely to live for 3 years. We need to find biomarkers to help us identify the long-term survivors with the drug.”
Median duration of response was 22.3 months with atezolizumab compared with 7.2 months with docetaxel.
Researchers noted the safety profile of atezolizumab appeared more favorable than that of docetaxel, as demonstrated by previous reports.
Solange Peters, MD, PhD, head of medical oncology at Centre Hospitalier Universitaire Vaudois in Lausanne, Switzerland, and ESMO president elect, suggested that the next step would be identifying patients with advanced NSCLC who were most likely to survive long term after immunotherapy.
“These trials should be conducted [among] patients with similar characteristics to the long-term survivors in the phase 1 and phase 2 trials with atezolizumab, pembrolizumab [Keytruda, Merck] and nivolumab [Opdivo, Bristol-Myers Squibb],” Peters said in the press release. “So, the first step will be to describe these patients in terms of demographics, smoking history, tumor mutation burden, expression of immune genes and PD-L1 expression. Focusing future studies on these patients will help us to discover a biomarker signature for use in clinical practice.” – by Andy Polhamus
Reference:
Maziéres J, et al. Abstract 136PD_PR. Presented at: European Lung Cancer Congress; April 11-14, 2018; Geneva.
Disclosures: F. Hoffman-La Roche/Genentech funded this study. Maziéres reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.