medwireNews: Patients with nonsquamous non-small-cell lung cancer (NSCLC) who have sensitizing EGFR mutations or liver metastases may benefit from the addition of atezolizumab to bevacizumab and chemotherapy, IMpower150 trial data show.
The previously published primary analysis of the study showed that the combination of atezolizumab, bevacizumab, carboplatin, and paclitaxel (ABCP) significantly improved progression-free survival (PFS) and overall survival (OS) relative to the standard-of-care bevacizumab plus carboplatin and paclitaxel (BCP) in chemotherapy-naïve patients with nonsquamous NSCLC, but the analysis excluded patients with EGFR or ALK genetic alterations.
The current secondary analysis of the phase III trial, carried out by Martin Reck (German Centre for Lung Research, Grosshansdorf) and colleagues, assessed the efficacy of ABCP or atezolizumab plus carboplatin and paclitaxel (ACP) versus BCP in a number of key patient subgroups.
As reported in The Lancet Respiratory Medicine, median PFS was significantly longer with ABCP than with BCP in patients with sensitizing EGFR mutations (n=58; 10.3 vs 6.1 months) and in those with liver metastases at baseline (n=109; 8.2 vs 5.4 months), with a significant 59% reduction in the risk for disease progression or death observed in both subgroups.
Median overall survival (OS) was not reached among the patients with sensitizing EGFR mutations who received ABCP and was 13.3 months in those with liver metastases, both of which were significantly longer than the respective 17.5 and 9.4 months achieved among the patients who received BCP. This equated to 69% and 48% lower risks for death with ABCP versus BCP for patients with sensitizing EGFR mutations and liver metastases, respectively.
The team also found that median OS was significantly longer with ABCP than with BCP in the entire intention-to-treat population (n=400 per treatment group; 19.8 vs 14.9 months), which included patients with both sensitizing and nonsensitizing EGFR mutations, as well as those with ALK alterations. In this group, the risk for death during approximately 20 months of follow-up was 24% lower with ABCP than with BCP.
Of note, there was no significant difference between BCP and ACP in any of the outcomes tested.
“The observation of improved progression-free survival with ABCP versus BCP, without a similar benefit with ACP versus BCP, in patients with sensitising EGFR mutations suggests that the combination of atezolizumab and bevacizumab added on to the carboplatin plus paclitaxel regimen could provide benefit in this patient population,” Reck et al remark.
They conclude that “[t]he ABCP regimen might represent a potential new therapy option” for the key patient subgroups they studied, “especially those with sensitising EGFR mutations who have progressed on TKI therapy.”
By Laura Cowen
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Lancet Respir Med 2019; doi:10.1016/S2213-2600(19)30084-0
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