KEY TAKEAWAYS
- The phase III trial evaluated the efficacy of atezolizumab + bevacizumab + chemo vs. chemo alone in EGFR/ALK-mutated NSCLC after TKI progression.
- The primary endpoint was PFS.
- The study showed that anti-PD-L1 Combo benefits in EGFR/ALK-mutated NSCLC after targeted therapy progression.
The role of anti-PD-(L)1 antibody in non-small cell lung cancer (NSCLC) treatment with a driver mutation remains uncertain, particularly in the context of its administration following tyrosine kinase inhibitor (TKI) therapy.
Researchers aimed to evaluate the efficacy of atezolizumab + bevacizumab + chemo vs. chemo alone in EGFR/ALK-mutated NSCLC after TKI progression. The study assessed the clinical effectiveness of atezolizumab+ bevacizumab/paclitaxel/carboplatin (ABCP arm) accompanied by maintenance therapy with atezolizumab plus bevacizumab, comparing it to pemetrexed + carboplatin or cisplatin (PC arm) followed by pemetrexed maintenance. The primary endpoint was progression-free survival (PFS).
About 228 patients with EGFR mutation (n=215) or ALK translocation (n=13) were involved from various 16 sites in the Republic of Korea and randomized (2:1) ratio to either ABCP (n=154) or PC arm (n=74). The median follow-up was 26.1 months (95% CI 24.7-28.2). ABCP demonstrated higher objective response rates(ORR) compared to PC (69.5% vs 41.9%, P <0.001). Median PFS was significantly prolonged in the ABCP arm (8.48 months vs. 5.62 months, HR 0.62 [0.45-0.86], P=0.004).
PFS benefit increased with higher PD-L1 expression, with HR of 0.47, 0.41, and 0.24 for PD-L1 ≥1%, ≥10%, and ≥50%. Overall survival(OS) was the same among ABCP and PC groups (20.63 months vs. 20.27 months, HR 1.01 [0.69-1.46], P=0.975). The safety profile of the ABCP arm was consistent with previous reports, showing no additional safety signals.
The study showed that anti-PD-L1 combo benefits in EGFR/ALK-mutated NSCLC after targeted therapy progression.
Clinical Trial: https://www.clinicaltrials.gov/study/NCT03991403
Ahn M, Park S, Kim TM, Han J, Lee G, Shim B, Lee Y, Kim S, Kim I, Lee S, Kim YJ, Park JH, Park SG, Lee KH, Kang EJ, Kim JW, Shin S. A phase III, randomized study of atezolizumab plus bevacizumab and chemotherapy in patients with EGFR or ALK mutated non-small cell lung cancer (ATTLAS, KCSG-LU19-04). Ann Oncol. 2023;34(suppl_2):S1254-S1335. doi:10.1016/annonc/annonc1358.
