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Adjuvant Atezolizumab Improves Disease-Free Survival in Resected PD-L1–Positive NSCLC
Despite undergoing complete surgical resection, many patients with stage IB–IIIA non–small-cell lung cancer (NSCLC) suffer recurrent metastatic disease. Adjuvant platinum-based combination chemotherapy, the current standard of care for these patients, results in a modest 4% to 5% overall survival improvement. Recently, adjuvant osimertinib therapy produced significant disease-free survival improvement in patients whose resected lung cancer harbored EGFR mutations.
The phase 3 IMpower010 trial randomized 1005 patients with stage IB–IIIA NSCLC who had undergone complete resection and adjuvant chemotherapy to either adjuvant atezolizumab for one year or best supportive care. Treatment with atezolizumab led to statistically significant improvements in disease-free survival in patients with stage II–IIIA disease whose tumors expressed PD-L1 on 1% of tumor cells (hazard ratio, 0.66; 95% CI 0.50–0.88; P=0.0039), and among all patients with stage II–IIIA disease regardless of PD-L1 expression (HR, 0.79; 0.64–0.96; P=0.020). In the intention-to-treat population (IB–IIIA), adjuvant atezolizumab did not cross the significance boundary (HR, 0.81; 95% CI 0.67–0.99; P=0.040). Treatment was well tolerated, and no new safety signals were noted.
Comment
Adjuvant atezolizumab represents an important step forward for patients with resected lung cancer by improving disease-free survival. Overall survival results are much anticipated. It is likely that patients with the highest levels of PD-L1 expression (tumor proportion score >50%) derived the most benefit from this therapy. This work underscores the importance of assessing PD-L1 status in resected specimens and of further study of biomarkers that will eventually best identify patients who will derive the greatest benefit from adjuvant atezolizumab.
Citation(s)
Author:
Felip E et al.
Title:
Adjuvant atezolizumab after adjuvant chemotherapy in resected stage IB-IIIA non-small-cell lung cancer (IMpower010): A randomised, multicentre, open-label, phase 3 trial.
Source:
Lancet
2021
Sep
20; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
Jyoti D. Patel, MD, FASCO