In a phase 3 trial of patients with advanced or metastatic non-small-cell lung cancer (NSCLC), atezolizumab monotherapy produced improved overall survival, twice the 2-year survival rate, maintenance of quality of life, and a favorable safety profile, compared with single-agent chemotherapy. “These data support atezolizumab monotherapy as a potential first-line treatment option for patients with advanced NSCLC who are ineligible for platinum-based chemotherapy,” the authors conclude.
Conducted at 91 sites in 23 countries across Asia, Europe, North America, and South America, the open-label study included eligible patients with stage IIIB or IV NSCLC who could not receive platinum-doublet chemotherapy because of an Eastern Cooperative Oncology Group performance status (ECOG PS) of 2 or 3 and patients 70 years or older with an ECOG PS 0–1 with substantial comorbidities or contraindications for platinum-doublet chemotherapy. Block randomized to intravenous atezolizumab 1200 mg every 3 weeks or single-agent chemotherapy at 3-weekly or 4-weekly cycles, patients had overall survival rates in the intention-to-treat population: “Between Sept 11, 2017, and Sept 23, 2019, 453 patients were enrolled and randomised to receive atezolizumab (n = 302) or chemotherapy (n = 151). Atezolizumab improved overall survival compared with chemotherapy (median overall survival 10.3 months [95% CI 9.4–11.9] vs 9.2 months [5.9–11.2]; stratified hazard ratio 0.78 [0.63–0.97], P = 0.028), with a 2-year survival rate of 24% (95% CI 19.3–29.4) with atezolizumab compared with 12% (6.7–18.0) with chemotherapy. Compared with chemotherapy, atezolizumab was associated with stabilisation or improvement of patient-reported health-related quality-of-life functioning scales and symptoms and fewer grade 3–4 treatment-related adverse events (49 [16%] of 300 vs 49 [33%] of 147) and treatment-related deaths (three [1%] vs four [3%]).”