Real-world data shows inferior survival compared with IMpower150 results

A preliminary analysis of real-world, all-comer data suggested that progression-free survival (PFS) and overall survival (OS) in patients with non-squamous non-small-cell lung cancer (NSCLC) may be inferior to PFS and OS seen in the IMpower150 trial. Further analysis of real-world use of this protocol is needed [1].

The IMpower150 study (NCT02366143) found that the addition of atezolizumab to bevacizumab plus chemotherapy treatment protocol significantly improved PFS and OS among patients with metastatic non-squamous NSCLC. However, real-world data on the use of this regimen in patients with oncogene driven tumours and central nervous system (CNS) metastases (i.e. brain, or leptomeningeal disease [LMD]) is lacking.

To address this gap, Dr Samantha Dean (Austin Health, Australia) and colleagues retrospectively assessed records of 97 patients with stage 4 NSCLC who had been treated in accordance with the IMpower150 regimen. They correlated PFS and OS data with mutational status and the presence of CNS metastases. Of the 97 patients analysed, 86 had an identified oncogene, and 59 had CNS metastases (brain, 46; LMD, 13).

Median PFS in the overall population was 5.4 months. In patients with an epidermal growth factor receptor (EGFR) mutation, median PFS was 5.1 months. In patients with brain metastases, median PFS was 5.8 months; in patients with LMD, it was 4.3 months.

Median OS in the overall population was 8.85 months. In patients with an EGFR mutation, the median OS was 7.6 months. In patients with brain metastases, median OS was 8.1 months; in patients with LMD, it was 5.7 months.

Researchers concluded that the most common use of the IMpower150 protocol occurred in patients with an EGFR mutation. The inferiority of PFS and OS data as compared with the original IMpower150 trial results was attributed to immature follow-up, and the inclusion of patients with poorer performance status and/or CNS disease (excluded from the original trial). They additionally concluded that the IMpower150 regimen constituted an effective therapeutic option for patients with LMD.

1. Dean S. Atezolizumab, bevacizumab and chemotherapy (IMpower150) in stage IV non-small cell lung cancer: the Australian experience. P16.02, WCLC 2021, 8–14 September.

 

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Posted on 21 September 202129 February 2024