Immunotherapy Improves Long-Term Survival in NSCLC Patients

A global study—led by the University College London (UCL) and University College London Hospital (UCLH) and sponsored by Roche—has shown that cancer immunotherapy with atezolizumab significantly improved the overall survival of advanced stage non-small cell lung cancer (NSCLC) patients who were not able to be treated with platinum-containing chemotherapy, when compared to single-agent chemotherapy.

The trial results, published recently in The Lancet, are good news for NSCLC patients who are not eligible for standard-of-care platinum-based chemotherapy, due to concerns about their ability to withstand the treatment.

Lung cancer is the leading cause of cancer death worldwide, with around 2.2 million new cases and 1.8 million deaths a year. The majority of patients present with advanced-stage NSCLC.

Lack of immunotherapy options for non-small cell lung cancer

For the fittest patients with advanced-stage NSCLC, first-line immunotherapy with or without platinum-based doublet chemotherapy (PDC) is now established as the standard of care treatment. This follows several randomized trials that were limited to “fit” participants with a median age of 65 or younger and were able to tolerate PDC.

However, more than 40 percent of advanced-stage NSCLC patients are in poor health and are often elderly with significant medical comorbidities. Treatment with standard PDC is not suitable for many of these patients because of poor tolerance or toxicity concerns, leaving them with limited treatment options. They are frequently treated with less effective single-agent chemotherapy or offered the best supportive care.

Currently, most treatment guidelines do not recommend immunotherapy treatment due to a lack of randomized results to indicate it is safe, well tolerated, and increases overall survival for this population.

Findings of the first Phase 3 trial with Atezolizumab

Supported by Roche, this is the first reported randomized Phase 3 trial of first-line immunotherapy treatment with atezolizumab (also known as Tecentriq) in an advanced NSCLC population deemed unfit for standard platinum-chemotherapy. The trial sought to establish the efficacy, safety, and overall survival rate of first-line immunotherapy treatment with atezolizumab compared with single-agent chemotherapy in advanced-stage NSCLC patients. Patients were randomized 2:1, with 302 patients receiving atezolizumab and 151 receiving single-agent chemotherapy.

The study showed that atezolizumab significantly improved overall survival and resulted in a clinically meaningful long-term survival benefit, with twice as many patients (24 percent) who were treated with atezolizumab remaining alive at two years compared to those treated with chemotherapy (12 percent). Over 50 percent of chemotherapy patients were still alive at two years receiving subsequent immunotherapy.

Siow-Ming Lee, MBBS, PhD, FRCP, professor at UCL Cancer Institute and medical consultant at UCLH, who chaired the study Steering Committee and conceptualized the study design, said: “For over two decades, clinical trials have failed to provide significant therapeutic benefits to older NSCLC patients with poor health who are unfit for standard platinum doublet chemotherapy. IPSOS is the first randomized trial to show that immunotherapy treatment with first-line atezolizumab treatment significantly improves overall survival compared to single-agent chemotherapy for these poor prognosis patients, with twice as many remaining alive at two years. The treatment also resulted in stabilized or improved health-related quality of life measures, and no new safety concerns were identified.”

- This press release was originally published on the University College London website