Authors: Georgia Patey, Future Science Group
According to Martin Reck (Chief Oncology Physician at the Hospital Grosshansdorf, Germany), the immunotherapy atezolizumab may substantially alter treatment of patients with refractory lung cancer, following results from the POPLAR and BIRCH studies that demonstrate its efficacy across lines. These first results were presented at the 2015 European Cancer Congress this weekend (26 – 29 September, Vienna, Austria).
“In the BIRCH trial the PD-L1 antibody atezolizumab showed a remarkable activity in a large number of patients regardless of the line of treatment,” commented Reck. “The profile of adverse events is in line with reported data from other PD-1/PD-L1 checkpoint inhibitors and overall tolerability looks quite favorable. The efficacy as shown by the response rate was in correlation with PD-L1 expression on tumor and immune cells favoring tumors with high PD-L1 expression.”
“In confirmation the randomized POPLAR trial reported a superior overall survival for unselected patients who received atezolizumab as second-line treatment compared to docetaxel,” Reck continued. “Again efficacy could be correlated to the PD-L1 expression status with the highest overall survival benefit in patients with TC3 and IC3 (high PD-L1 expressing tumors). The data have to be validated by a large randomized Phase III trial, which is ongoing.”
In comparison with the other currently available therapies for lung cancer, Reck commented: “Atezolizumab is the second checkpoint inhibitor to show a superior efficacy and better tolerability compared to standard second-line chemotherapy in patients with pretreated non-small-cell lung cancer. Therefore it is to be expected that atezolizumab, like other PD-1 and PD-L1 antibodies, will substantially change treatment strategies of patients with refractory lung cancer.”
Reck pointed out that first-line treatment is also promising: “First-line treatment with atezolizumab in patients with PD-L1 high expressing tumors or the combination of atezolizumab with platinum-based chemotherapy remains an attractive option and is currently being investigated in large randomized Phase III trials. Furthermore, activity is also seen in different tumors like small-cell lung cancer and mesothelioma and will be explored in upcoming trials.”
Based on the results of the POPLAR and BIRCH trials, as well as other reported data with the PD-1 antibody nivolumab, pretreatment of patients is expected to dramatically change. Nivolumab was approved recently by the EMA for treatment of refractory squamous cell non-small-cell lung cancer.
“In particular, the option for long-lasting responses and stabilization in combination with an attractive tolerability profile will impact clinical practice,” commented Reck. “Whether patients should be selected using a biomarker strategy still needs to be determined and remains a significant challenge based on the multiple different companion diagnostics that are in use for the particular agents. Depending on the results of ongoing trials front-line treatment with a checkpoint inhibitor in selected patients could be an interesting option.”