ESMO 2021: Immune checkpoint inhibitor atezolizumab as a potential game-changer in the treatment of early-stage NSCLC

20 Sep 2021
ESMO 2021: Immune checkpoint inhibitor atezolizumab as a potential game-changer in  the treatment of early-stage NSCLC

With an estimated 2.2 million new cancer cases and 1.8 million deaths globally, lung cancer is the second most commonly diagnosed cancer and the
leading cause of cancer death in 2020, representing approximately one in 10 cancers diagnosed and one in 5 deaths. 

Non–small cell lung cancer (NSCLC) is the most prevalent type and accounts for approximately 84% of all lung cancers. 

Considering these statistics, there is a critical need to seek out and develop more potent treatment opportunities aimed at treating lung cancer, especially for patients with early-stage NSCLC. In response, the phase III IMpower010 multicenter, open-label, randomised trial sought to open up a new therapeutic avenue for this particular patient population.

IMpower010 was designed to compare the efficacy and safety of an immune checkpoint inhibitor, atezolizumab, compared with best supportive care as adjuvant therapy in patients with stage IB-stage IIIA NSCLC following resection and adjuvant chemotherapy.

The study enrolled a total of 1280 patients across 231 sites, including VHIO, who received up to four cycles of adjuvant chemotherapy.

More than 1000 patients were then randomised in a 1:1 ratio to receive immune-based therapy, atezolizumab, or best supportive care.

Importantly, IMpower010 is the very first clinical trial to have demonstrated that immunotherapy significantly improves disease-free survival in these patients compared with best supportive care alone, particularly in tumours expressing PD-L1.

Building on these primary results, reported earlier this year at the American Society of Clinical Oncology (ASCO) Virtual Annual Meeting, 04 – 08 June, late-breaking data of IMpower010 interim disease-free analysis were presented by lead investigator, Enriqueta Felip, at this week’s European Society for Medical Oncology (ESMO) virtual Congress 2021.

Now, results from exploratory analyses of sites of disease relapse and subsequent therapy with atezolizumab compared with best supportive care in patients with stage II and III, report significantly less disease recurrence as well as improved disease-free survival, particularly in those patients whose tumours expressed PD-L1.

Reflective of the relevance of these findings, data from this study published simultaneously in The Lancet.

“Patients with early-stage NSCLC are at high-risk of disease relapse despite adjuvant chemotherapy. Improving disease-free survival therefore represents an unmet and critical clinical need.

Considering our data, atezolizumab is certainly stepping up as more effective therapy for this patient population,” said Enriqueta Felip, Principal Investigator of VHIO’sThoracic Tumors & Head and Neck Group, and Head of the Thoracic Cancer Unit at the Vall d’Hebron University Hospital (HUVH - Vall d’Hebron Barcelona Hospital Campus).

The IMpower010 investigators show that in resected patients with stage II and IIIA and tumors positive for PD-L1 expression, disease relapse was observed in 29% of cases compared with 44.7% in the control arm of the study.

Latest data also shows disease-free survival at two years in 74.6% of these patients who were treated with immunotherapy, versus 61% in patients receiving best supportive care.

Results also report a greater benefit of treatment this therapy in patients whose tumours expressedPD-L1>50%.

“Results from this landmark study promise a potential paradigm shift in the treatment of patients with resected, early-stage non-small cell lung cancer.

They also shine important light on more effectively combating high-risk cancer in the early-stage setting before it spreads, as well as potentially preventing the disease recurrence,” concluded Enriqueta Felip, who also serves on the International Association for the Study of Lung Cancer’s (IASLC)  Board of Directors (2019-2021) as Secretary.

Watch our video interview with Dr Enriqueta Felip here.

Source: ESMO