Atezolizumab Plus Chemo, Bevacizumab Yield Minimal Treatment Burden in Nonsquamous NSCLC

In a study of patients with nonsquamous non–small-cell lung cancer (NSCLC), first-line atezolizumab combined with chemotherapy and bevacizumab (ABCP) was shown to be more tolerable and manageable than bevacizumab plus chemotherapy alone (BCP; J Clin Oncol. 2020 May 27. Epub ahead of print).

According to lead investigator Martin Reck, MD, PhD, Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Germany, and colleagues, ABCP has a demonstrated survival benefit over BCP in this patient population.

Thus, Dr Reck et al focused their study on the safety and patient-reported outcomes (PROs) of adding atezolizumab to chemotherapy with and without bevacizumab in patients with nonsquamous NSCLC.

The primary end points of the study were overall survival and investigator-assessed progression-free survival, and a secondary end point was PROs, assessed in accordance with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ)-Core 30 and EORTC QLQ-Lung Cancer 13.

Dr Reck and colleagues also evaluated the incidence, nature, and severity of adverse events (AEs).

A total of 1187 evaluable patients were randomized to receive BCP (n = 394), atezolizumab plus carboplatin and paclitaxel (ACP; n = 400), or ABCP (n = 393).

The majority of patients had grade 3/4 treatment-related AEs during the induction versus maintenance phase of their therapy (ACP, 40.5% vs 8.2%; ABCP, 48.6% vs 21.2%; BCP, 44.7% vs 11.1%, respectively).

Patients receiving ACP, ABCP, and BCP had serious AE incidence rates of 28.3%, 28.5%, and 26.4%, respectively, during induction. The incidence rates of serious AEs during maintenance therapy were 20.0%, 26.3%, and 13.0%, respectively.

More than 88% of patients completed the PRO questionnaires at baseline, and ≥70% continued to complete the questionnaires throughout most study visits. Across all treatment arms and through cycle 13, there was no clinically meaningful worsening of global health status or physical functioning scores reported.

All patients in the study rated common symptoms with chemotherapy and immunotherapy similarly, regardless of the treatment regimen they received.

“ABCP seems tolerable and manageable versus ACP and BCP in first-line nonsquamous NSCLC. Treatment tolerability differed between induction and maintenance phases across treatment arms,” Dr Reck and co-investigators concluded.

“PROs reflect a minimal treatment burden (eg, health-related quality of life, symptoms) with each regimen,” they added.—Hina Porcelli