Atezolizumab (Tecentriq®, Genentech Inc.) in combination with nab-paclitaxel and carboplatin is now FDA approved as first-line treatment of adult patients with metastatic non-squamous non-small cell lung cancer (NSCLC) with no EGFR or ALK genomic tumor aberrations.
Atezolizumab, previously approved to treat extensive-stage small cell lung cancer, metastatic urothelial carcinoma, and metastatic triple-negative breast cancer, works as a monoclonal antibody and stimulates the immune system by blocking the activity of programmed death ligand 1—a molecule found on T cells that suppresses immune activity. T cells are then able to function better and fight cancer cells.
Approval was based on IMpower130 (NCT02367781), a multicenter, randomized, open-label trial that enrolled patients with stage IV non-squamous NSCLC, who had not received chemotherapy for the disease, but could have previously received EGFR or ALK kinase inhibitors. A total of 724 patients were randomized in a 2:1 ratio to receive either atezolizumab, nab-paclitaxel, and carboplatin, followed by single-agent atezolizumab or nab-paclitaxel and carboplatin, followed by maintenance pemetrexed.
The results revealed that the median progression-free survival was improved in the atezolizumab arm compared to the control arm (7.2 months vs 6.5 months). In addition, the median overall survival was significantly improved in the atezolizumab arm (18.6 months vs 13.9 months).
The most common treatment-related adverse events of the atezolizumab combination included fatigue, asthenia, nausea, alopecia, constipation, diarrhea, and decreased appetite.
The recommended dose for atezolizumab is 1200 mg, given as an intravenous infusion every three weeks. Atezolizumab should be dispensed first, before chemotherapy, on days when they are both administered to the patient.
For More Information
Clinicaltrials.gov (2019). A study of atezolizumab in combination with carboplatin plus (+) nab-paclitaxel compared with carboplatin + nab-paclitaxel in participants with stage IV non-squamous non-small cell lung cancer (NSCLC) (IMpower130). NLM identifier: NCT02367781.
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