Progression-free survival (PFS) was improved in patients with advanced non-squamous non-small cell lung cancer (NSCLC) using a combination of Avastin (bevacizumab), Tecentriq (atezolizumab), and chemotherapy in a Phase 3 clinical trial.
The Phase 3 IMpower150 trial (NCT02366143) enrolled 1,202 patients with NSCLC who had not previously undergone chemotherapy. They were randomized to receive Genentech’s Tecentriq plus chemotherapy (group A), Avastin (also marketed by Genentech) plus Tecentriq and chemotherapy (group B), or Avastin plus chemotherapy (group C). The chemotherapy treatment used was carboplatin plus paclitaxel.
The results were presented at the European Society for Medical Oncology (ESMO) Immuno-Oncology Congress 2017 in a presentation titled, “Primary PFS and safety analyses of a randomized Phase III study of carboplatin + paclitaxel +/− bevacizumab, with or without atezolizumab in 1L non-squamous metastatic NSCLC (IMpower150),” on Dec. 7, 2017.
Only groups B and C were compared in this presentation.
Avastin is designed to inhibit the formation of new blood vessels (a process called angiogenesis) in tumors that allow them to thrive. It is hoped that combining Avastin with Tecentriq, a checkpoint inhibitor (which inhibits the molecule programmed death-ligand 1, PD-L1), will reinforce Tecentriq’s anti-tumor effects.
Results showed that PFS in group B rose to values ranging from 7.7 to 9.8 months versus 6.0 to 7.1 months in group C. In the patients in group B who lacked gene mutations in their tumors, PFS ranged around 11.3 months. Serious adverse events (severe but not life-threatening) occurred in 25% of the patients in group B versus 19% in group C.
“This is the first phase III trial to report on the combination of chemotherapy, antiangiogenic treatment and immunotherapy as first line treatment for advanced non-squamous NSCLC,” Martin Reck, chief oncology physician, Department of Thoracic Oncology, Lung Clinic Grosshansdorf, Germany, said in a press release.
“There were no new safety signals or toxicity issues with this combination so it appears to be a feasible approach for this group of patients” Reck added.
The results suggest that it is possible to improve the effectiveness of chemotherapy-based treatment in patients with advanced non-squamous NSCLC through immunotherapy.
“These exciting results pave the way for a new standard of care in advanced non-squamous NSCLC,” said Solange Peters, head of medical oncology, Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
“When you look at the 12-month PFS, you double the number of patients who have not progressed from 18% without immunotherapy to 37% when you add the immunotherapy,” Peters sais. “This is very, very promising.”
Nonetheless, the team emphasized that although the initial overall survival data looks encouraging, further studies are needed.
“In the next year, other trials will report results in frontline treatment-naïve NSCLC patients using the combination of chemotherapy and immunotherapy or the combination of two immunotherapy drugs. The challenge will then be to judge which strategy is the best,” Peters said.
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