Chemoimmunotherapy for stage IV non-small-cell lung cancer

Howard West and colleagues 1 West H McCleod M Hussein M et al. Atezolizumab in combination with carboplatin plus nab-paclitaxel chemotherapy compared with chemotherapy alone as first-line treatment for metastatic non-squamous non-small-cell lung cancer (IMpower130): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. 2019; 20: 924-937 Summary Full Text Full Text PDF PubMed Scopus (790) Google Scholar reported the result of the IMPower130 study, which evaluated the role of chemotherapy in patients with treatment naive, stage IV adenocarcinoma of the lung. Patients were randomly assigned, in a 2:1 ratio, to receive either platinum doublet (carboplatin and nab-paclitaxel) plus atezolizumab or standard platinum doublet. After four or six cycles of induction therapy, patients were then given chemotherapy and atezolizumab or chemotherapy with best supportive care or pemetrexed. The study showed clinically meaningful survival benefit for patients receiving chemotherapy plus atezolizumab compared with those receiving chemotherapy alone (median overall survival of 18·6 months vs 13·9 months; stratified hazard ratio 0·79 [95% CI 0·64–0·98]). Atezolizumab in combination with carboplatin plus nab-paclitaxel chemotherapy compared with chemotherapy alone as first-line treatment for metastatic non-squamous non-small-cell lung cancer (IMpower130): a multicentre, randomised, open-label, phase 3 trialIMpower130 showed a significant and clinically meaningful improvement in overall survival and a significant improvement in progression-free survival with atezolizumab plus chemotherapy versus chemotherapy as first-line treatment of patients with stage IV non-squamous non-small-cell lung cancer and no ALK or EGFR mutations. No new safety signals were identified. This study supports the benefit of atezolizumab, in combination with platinum-based chemotherapy, as first-line treatment of metastatic non-small-cell lung cancer. Full-Text PDF Chemoimmunotherapy for stage IV non-small-cell lung cancer – Authors' replyWe appreciate Dipesh Uprety's thoughtful comments. Liver metastasis, considered a poor prognostic factor, has been used for stratification in trials of first-line atezolizumab plus chemotherapy in non-small-cell lung cancer. In IMpower150,1,2 a significant overall survival benefit was shown in participants receiving atezolizumab plus bevacizumab plus carboplatin and paclitaxel compared with those receiving bevacizumab plus carboplatin and paclitaxel both in the entire intention-to-treat population (hazard ratio [HR] 0·76 [95% CI 0·63–0·93]) and in the subset of the intention-to-treat population with wild-type EGFR and ALK (HR 0·78 [0·64–0·96]). Full-Text PDF