The addition of atezolizumab to bevacizumab/carboplatin/paclitaxel (BCP) significantly prolongs overall survival in patients with non-squamous non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations, according to results of a final efficacy analysis presented this week at the European Medical Society for Oncology (ESMO) Virtual Congress 2020.
"Atezolizumab inhibits programmed death-ligand 1 (PD-L1) to restore anti-cancer immunity; bevacizumab may enhance atezolizumab's efficacy by inhibiting vascular endothelial growth factor (VEGF) immunosuppression and promoting T cell tumor infiltration," comment the investigators of the phase 3 IMPOWER150 trial, led by first author Martin Reck, MD, PhD, Head of Thoracic Oncology at the German Center for Lung Research in Grosshansdorf, Germany. IMpower50 investigated the efficacy of adding atezolizumab to BCP (ABCP) compared with BCP alone and with atezolizumab/carboplatin/paclitaxel (ACP) in 1,202 patients with non-squamous NSCLC. Dr. Reck and colleagues evaluated the combination's efficacy in a subgroup of 123 patients with EGFR mutations, including those with sensitizing EGFR mutations (exon 19 deletions or L858R mutations) and those with sensitizing EGFR mutations who had received prior tyrosine kinase inhibitor (TKI) therapy.
Of the 123 patients with EGFR mutations, 91 had sensitizing mutations. All patients received carboplatin in an area under the curve (AUC) concentration of 6 mg/mL per minute and paclitaxel 200 mg/m2, in addition to either atezolizumab 1,200 mg, bevacizumab 15 mg/kg, or both. Treatments were administered once every three weeks for either four or six cycles, followed by maintenance therapy every three weeks with atezolizumab, bevacizumab, or both. The primary end points of the subgroup analysis were overall survival in patients with EGFR mutations, those with sensitizing EGFR mutations, and those with sensitizing EGFR mutations previously treated with TKIs.
At a median follow-up of 39.3 months, ABCP significantly increased median overall survival in patients with EGFR mutations compared with ACP and with BCP (26.1 vs 21.4 vs 20.3 months). Median overall survival was also prolonged with ABCP compared with ACP and BCP in patients with sensitizing EGFR mutations (29.4 vs 19.0 vs 18.1 months) and in patients with sensitizing EGFR mutations who had received prior TKI therapy (27.8 vs 14.9 vs 18.1 months). Neither ACP nor BCP showed a survival benefit across mutation subgroups.
"With approximately 20 additional months of follow-up, ABCP continued to show an overall survival benefit versus BCP in patients with sensitizing EGFR mutations, including those who had prior treatment failure with TKIs," conclude Dr. Reck and colleagues. "The ABCP regimen may represent a new option for patients with sensitizing EGFR mutations for whom TKIs have failed."
For More Information
Reck M, Mok T, Socinski MA, et al (2020). IMpower50: updated efficacy analysis in patients with EGFR mutations. Ann Oncol (ESMO Virtual Congress Abstracts), 31(suppl_4):S754-S840. Abstract 1293P. DOI:10.1016/annonc/annonc283
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