Atezolizumab (Tecentriq®, Genentech, Inc.) was recently approved by the FDA for the first-line treatment of patients with metastatic non-small cell lung cancer (NSCLC) with high expression of programmed death ligand-1 (PD-L1). The approval was based on IMpower110, a phase 3 trial led by David Spigel, MD, Chief Scientific Officer and Director of the Lung Cancer Research Program at Sarah Cannon Research Institute in Nashville, Tennessee. In this interview with i3 Health, Dr. Spigel discusses the significance of atezolizumab's approval and shares his advice for treating patients with PD-L1–high metastatic NSCLC.
What are some of the most challenging aspects of treating patients with PD-L1–high metastatic NSCLC?
David Spigel, MD: Just like in any other newly diagnosed setting (PD-L1 zero, low, or high), you have to consider the pace of the cancer, symptoms, time to get therapy started, clinical trial options, and molecular testing needed, such as comprehensive next-generation sequencing (NGS) testing.
Can you comment on the significance of the approval of atezolizumab for these patients?
Dr. Spigel: Previously, the only immunotherapy options for patients with newly diagnosed advanced NSCLC were either pembrolizumab alone for PD-L1–high tumors or pembrolizumab plus chemotherapy for tumors with any or no PD-L1 expression. Most recently, we have received approval to use nivolumab/ipilimumab for tumors with any PD-L1 expression, as well as nivolumab/ipilimumab plus chemotherapy for those with any or no expression. This approval of atezolizumab makes it the only other immunotherapy monotherapy regimen available for our patients with high PD-L1–expressing NSCLC. This also has implications in research, where atezolizumab can now serve as a control.
Are there any particular adverse events that physicians and nurses should monitor for in patients receiving atezolizumab?
Dr. Spigel: Atezolizumab has no safety signals different from what we anticipate with any other checkpoint inhibitor.
What questions do you commonly encounter from patients with PD-L1–high metastatic NSCLC about their treatment, and how do you counsel them?
Dr. Spigel: Patients want to know what their options are, as well as the risks of these options. Many patients are not familiar with the idea of immunotherapy, but they are encouraged when they learn about its potential for them.
About Dr. Spigel
David Spigel, MD, is the Chief Scientific Officer and Director of the Lung Cancer Research Program at Sarah Cannon Research Institute in Nashville, Tennessee. He is also a partner with Tennessee Oncology. Dr. Spigel specializes in the treatment of adult malignancies, including lung cancer. He has led and overseen numerous clinical trials investigating novel immunotherapies and targeted therapies for lung cancer, many of which have led to new approvals.
For More Information
Spigel D, de Marinis F, Giaccone G, et al (2019). IMpower110: interim overall survival (OS) analysis of a phase III study of atezolizumab (atezo) vs platinum-based chemotherapy (chemo) as first-line (1L) treatment (tx) in PD-L1–selected NSCLC. Ann Oncol (ESMO Congress Abstracts), 30(suppl_5):v851-v934. Abstract 6256. DOI:10.1093/annonc/mdz394
Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of i3 Health.