Xagena.net - Update in Medicine

Patients with stage IV squamous non-small cell lung cancer ( NSCLC ) enrolled in clinical trial to test the immunotherapy Atezolizumab ( Tecentriq ) and chemotherapy against chemotherapy alone experienced a longer survival rate, among a subgroup of patients with high PD-LI.

The data for the IMpower131 Trial was presented at the IASLC 2019 World Conference on Lung Cancer, hosted by the International Association for the Study of Lung Cancer.

IMpower131 is a randomized phase III trial of Atezolizumab plus chemotherapy versus chemotherapy alone as first-line therapy in stage IV squamous NSCLC, which is the most advanced form of the disease.
The five-year survival rate for those diagnosed with stage IV lung cancer is less than 10%.

The multi-center trial enrolled 1021 patients; the 343 patients in Arm B received Atezolizumab + Carboplatin + nab-Paclitaxel 100 mg/m2 qw.
There were 340 patients enrolled in Arm C who 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 arms.

Median overall survival ( OS ) in the intention-to-treat ( ITT ) population was 14.2 months in Arm B vs 13.5 months in Arm C not crossing the boundary for statistical significance.

In the PD-L1-high subgroup, median overall survival was 23.4 vs 10.2 months, respectively.

Treatment-related grade 3-4 adverse effects 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.

Final overall survival in Arm B vs C did not cross the boundary for statistical significance but clinically meaningful overall survival improvement was observed in the PD-L1-high subgroup, despite not being formally tested.

In conclusion, the study has provided additional evidence on the efficacy of immunotherapy in patients with lung cancer.
The strong benefit observed in high PD-L1 expressors highlights relevance of biomarkers for patient selection. ( Xagena )

Source: International Association for the Study of Lung Cancer ( IASLC ), 2019