Paper - Review

DOI: 10.1056/NEJMoa1716948

Abstract

Background

The cancer-cell-killing property ← of atezolizumab
→ may be enhanced
← by the blockade of vascular endothelial growth factor-mediated immunosuppression
← with bevacizumab

This open-label, phase 3 study
→ evaluated → 1⃣ atezolizumab 2⃣ bevacizumab 3⃣ chemotherapy
← in patients ← with metastatic non-squamouse NSCLC
← who had NOT ❌ previously received chemotherapy

Methods

Randomly assigned patients
→ to receive 1⃣ atezolizumab + carboplatin + paclitaxel (ACP) 2⃣ bevacizumab + carboplatin + paclitaxel (BCP) 3⃣ atezolizumab + BCP
← every 3 weeks for 4-6 cycles
→ followed by maintenance therapy
← with 1⃣ atezolizumab 2⃣ bevacizumab 3⃣ both

The two primary end points
→ were investigator assessed progression-free survival
← among patients in the intention-to-treat population ← who had a wild-type genotype
← among patients in the WT populations ← who had 1⃣ high expression of Teff gene signature 2⃣ overall survival ← in the WT poputation

Results

356 patients
→ were assigned → to the ABCP group
336 → to the BCP group

The median progression-free survival
→ was longer
← in the ABCP group > in the BCP group

The corresponding values
← in the Teff-high WT population
→ were 11.3 months & 6.8 months

Progression-free survival
→ was also longer
← in the ABCP group > in the BCP group
← in the entire intention-to-treat population
← among patient with (low & negative PD-L1 expression)
← 1⃣ those with Teff gene-signature expression 2⃣ those with liver metastases

Median overall survival
← among the patients in the WT population
→ was longer
← in the ABCP group > in the BCP group

The safety profile of ABCP
→ was consistent
← with previously reported → safety risks of the individual medicines

Conclusions

The addition of 1⃣ atezolizumab 2⃣ bevacizumab 3⃣ chemotherapy
→ significantly improved → 1⃣ progression-free survival 2⃣ overall survival
← among patients with metastatic non-squamous NSCLC
← regardless of 1⃣ PD-L1 expression 2⃣ EGFR 3⃣ ALK genetic alteration status

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