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Frontline Atezolizumab plus Bevacizumab in PD-L1–High NSCLC
Researchers in Spain assessed the clinical benefits and safety of atezolizumab (a PD-L1 inhibitor) plus bevacizumab (a vascular endothelial growth factor inhibitor) in patients with advanced nonsquamous non–small-cell lung cancer (NSCLC) with tumor mutational burden of 10 or more mutations/megabase and no EGFR, ALK, STK11, MDM2, or ROS1 translocations.
In the multicenter, single-arm, open-label, phase 2 study, 38 patients were treated with 1200 mg atezolizumab plus 15 mg/kg bevacizumab once every 21 days until disease progression or unacceptable toxicity. Participants had a mean age of 63.7 years, all were white, and most were men (74%) and current or prior smokers (97%).
The rate of progression-free survival (PFS) at 12 months — the primary endpoint — was 51.3% (95% CI, 34.2%–66.0%; data maturity, 96%). In addition, 42.1% of patients achieved an objective response and 78.9% achieved disease control. The most common adverse events with atezolizumab were fatigue (16%) and pruritus (16%); with bevacizumab, hypertension (26%) and proteinuria (11%). Adverse events led to discontinuation of atezolizumab in 2 patients and bevacizumab in 3 patients.
Of note, there was no association between PD-L1 expression and treatment response, PFS, or overalll survival.
Comment
Although the trial met its primary endpoint, the trial does not answer the question of whether bevacizumab added to atezolizumab improves outcome versus atezolizumab alone in this patient population. In the absence of a prospective, randomized clinical trial comparing these treatment strategies, this regimen should not yet be incorporated into clinical practice for the initial treatment of advanced NSCLC, particularly given the added toxic effects associated with bevacizumab.
Citation(s)
Author:
Provencio M et al.
Title:
Atezolizumab plus bevacizumab as first-line treatment for patients with metastatic nonsquamous non–small cell lung cancer with high tumor mutation burden: A nonrandomized controlled trial.
Source:
JAMA Oncol
2022
Dec
15; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
Jyoti D. Patel, MD, FASCO