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Unresectable non-small-cell lung cancer: concurrent Atezolizumab with chemoradiation


Consolidation Durvalumab after chemoradiation ( CRT ) is the current standard of care for locally advanced non-small-cell lung cancer ( NSCLC ).

Researchers have hypothesized that adding immunotherapy concurrently with CRT ( cCRT ) would increase efficacy without additive toxicity.

A phase II study was conducted in two parts.
Part 1 ( n = 10 ) involved administration of conventionally fractionated CRT followed by consolidation chemotherapy ( Atezolizumab [ two cycles ] and maintenance Atezolizumab up to 1 y ).
Part 2 ( n = 30 ) involved administration of cCRT with Atezolizumab followed by the same consolidation and maintenance therapies as in part 1.

Programmed cell death ligand-1 staining cutoffs ( 1% or 50% ) using Dako 22C3 immunohistochemistry were correlated with clinical outcomes.

The overall toxicities for part 1/2 were overall adverse events of grade 3 and above of 80%/80%; immune-related adverse events of grade 3 and above of 30%/20%; and pneumonitis of grade 2 and above of 10%/16%, respectively.

In part 1, for preliminary efficacy results, with a median follow-up of 22.5 months, the median progression-free survival ( PFS ) was 18.6 months, and the overall survival ( OS )was 22.8 months.

In part 2, with a median follow-up time of 15.1 months, the median progression-free survival was 13.2 months, and the overall survival was not reached.

There was no difference in cancer recurrence regardless of programmed cell death ligand-1 status.

In conclusion, Atezolizumab ( Tecentriq ) with cCRT is safe and feasible and has no added toxicities compared with historical rates. ( Xagena )

Lin SH et al, J Thorac Oncol 2020; 15: 248-257

XagenaMedicine_2020



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