First-line anti-PD-L1 therapy provides survival benefits for chemotherapy ineligible patients with NSCLC

September 2022 Cancer trials Nalinee Pandey

The results of the IPSOS clinical study show that the use of atezolizumab as first-line therapy significantly improved overall survival (OS) versus single-agent chemotherapy in patients with non-small-cell lung cancer (NSCLC). These findings were presented at the ESMO congress 2022.

Atezolizumab is an anti-PDL-1 immunotherapeutic drug. Its efficacy was evaluated in the treatment of patients with NSCLC. 

Study Design

The multicentre, global, open-label, randomized, phase-3, IPSOS study enrolled 453 patients (median age, 75 years) with locally advanced/metastatic NSCLC without driver mutations and were ineligible for first-line platinum-doublet chemo due to poor PS (≥2) or comorbidities in patients aged ≥70 yr. The participants were randomized (2:1) to receive either atezolizumab or single-agent chemotherapy (vinorelbine or gemcitabine). The study’s primary endpoint was OS whereas the secondary endpoints included OS rates, progression-free survival (PFS), overall response rate (ORR) etc.

Main Findings

After a median follow-up of 41 months, it was observed that atezolizumab significantly improved OS versus single-agent chemotherapy (stratified hazard ratio [HR] 0.78; 95% confidence interval [CI] 0.63–0.97; p=0.028). Its benefits were seen across key subgroups, including PD-L1 expression levels, performance status (PS) and histology. Clinical benefits were also seen in the two-year OS rate, ORR and DOR. Treatment-related adverse events (TRAEs) (grade ¾) were seen in 16.3% and 33% of patients in the atezolizumab and chemotherapy arms, respectively. Grade 5 TRAEs were observed in 1% and 2.7% of patients in the atezolizumab and chemotherapy arms, respectively.

Conclusion

The IPSOS is the first study that has evaluated the efficacy of single-agent immunotherapy in NSCLC patients with poor prognoses. The immunotherapy extended survival benefits with no new safety signals.

Reference

Lee SM, et al. IPSOS: Results from a phase 3 study of first-line (1L) atezolizumab (atezo) vs single-agent chemotherapy (chemo) in patients (pts) with NSCLC not eligible for a platinum-containing regimen. ESMO Congress 2022, LBA11

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