ASCO-SITC 2019—Neoadjuvant atezolizumab yields encouraging MPR rate in NSCLC


  • Melissa Pandika
  • Univadis
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Takeaway

  • Neoadjuvant atezolizumab resulted in a promising major pathological response (MPR) rate and was well-tolerated in patients with resectable NSCLC.

Why this matters

  • Results warrant further study of neoadjuvant atezolizumab in resectable NSCLC.
  • Biomarker analyses conducted could increase understanding of lung cancer immunology in neoadjuvant atezolizumab setting.

Study design

  • Preliminary analysis of first 54/180 planned patients with resectable, untreated NSCLC enrolled in phase 2, open-label, multicenter, single-arm LCMC3 trial.
    • Treatment with 2 cycles atezolizumab, 1200 mg on days 1, 22 presurgery.
    • Tumor biopsies, peripheral blood taken for biomarker analyses.  
  • Primary endpoint: MPR rate (10% viable tumor cells).
  • Funding: Genentech, Inc.

Key results

  • 45 patients in efficacy-evaluable population.
    • 10 (22%) achieved MPR (95% CI: 11%-37%).
  • Treatment-related adverse events (TRAEs) with >5% incidence were grade 1-2; 2 patients had grade 3 TRAEs.
  • 31 patients in biomarker evaluable population. After neoadjuvant atezolizumab:
    • Significant increases in natural killer cells, CD8+ T-cells, Th1-response-related dendritic cells; decrease in B-cells.
    • Immune subset changes related to MPR, programmed death-ligand 1 (PD-L1) status also observed.
    • Increase in PD-L1+ immune cells in most patients.

 Limitations

  • Trial ongoing (135 patients enrolled as of 2/28/2019).
  • More research needed on role of immune cell changes in clinical, pathological outcomes.