by Dr. C.H. Weaver M.D. updated 12/2018
Tecentriq® (atezolizumab) immunotherapy prolongs the survival of individuals with recurrent non-small cell lung cancer (NSCLC) when used as part of an initial treatment in combination with chemotherapy and when used as a single drug for individuals with recurrent cancer.
The US Food and Drug Administration (FDA) has approved Tecentriq® (atezolizumab) monotherapy and in combination with Avastin® (bevacizumab), paclitaxel and carboplatin (chemotherapy), for the first-line treatment of people with metastatic (NSCLC) with no EGFR or ALK genomic abnormalities.
This approval is based on results from the Phase III IMpower150 study, which showed that Tecentriq in combination with Avastin and chemotherapy helped people live significantly longer, compared to Avastin and chemotherapy.
Lung cancer remains the leading cause of cancer-related deaths worldwide. In the United States, NSCLC accounts for 75–80% of all lung cancers. Although progress has been made in recent years, the majority of patients with advanced stage lung cancer still die from their disease. New treatments are needed. Precision medicine continues to impact the lives of lung cancer patients with research into genomics and genetics leading to unprecedented progress in improving outcomes. Tailored treatments have emerged to match a person’s genetic makeup or a tumor’s genetic profile. As a result, patients with lung cancer now typically receive molecular testing that guides their physicians in determining which therapies are more likely to boost the chances of survival while limiting the potential for adverse effects. Results from studies evaluating immunomodulatory approaches using anti-PD-1 and anti-PD-L1 antibodies have demonstrated
Tecentriq is a monoclonal antibody designed to target and bind to a protein called PD-L1 (programmed death-ligand 1), which is expressed on cancer cells and cancer-infiltrating immune cells. PD-L1 interacts with PD-1 and B7.1, both found on the surface of T cells, causing inhibition of T cells. By blocking this interaction, Tecentriq may enable the activation of T cells, restoring their ability to effectively detect and attack cancer cells.
IMpower150 study for previously untreated stage IV NSCLC
The IMpower150 clinical trial compared Tecentriq in combination with chemotherapy (carboplatin and paclitaxel) with or without Avastin in people with stage IV or recurrent metastatic non-squamous NSCLC in 1202 previously untreated advanced NSCLC patients without a EGFR and ALK mutations. Individuals were treated with either one of 3 regimens and directly compared.
- Tecentriq plus carboplatin and paclitaxel
- Tecentriq and Avastin plus carboplatin and paclitaxel
- Avastin plus carboplatin and paclitaxel
The result of the study demonstrated that individuals treated with Tecentriq in combination with Avastin and chemotherapy were more likely to respond to treatment and survive compared to Avastin and chemotherapy. The median survival was improved from 14 to 19 months.
The rationale for combining Tecentriq and Avastin with chemotherapy is to target the cancer simultaneously with different medications and to enhance the potential of the immune system to combat the cancer by priming and activating a T cell response against cancer cell antigens.
Tecentriq Monotherapy for Recurrent NSCLC
The results of one study presented at ESMO 2016 reported the outcomes of 1,225 advanced or metastatic NSCLC patients whose disease had progressed following previous treatment with platinum-containing chemotherapy who were treated with either Tecentriq or Taxotere® (docetaxel). Tecentriq helped people live a median of 13.8 months, 4.2 months longer than those treated with Taxotere chemotherapy regardless of their levels of programmed death-ligand 1 (PD-L1) expression.
About Avastin (bevacizumab)
Avastin is an “angiogenesis inhibitor” biologic antibody designed to specifically bind to a protein called vascular endothelial growth factor (VEGF) that plays an important role throughout the lifecycle of a cancer to develop and maintain blood vessels, a process known as angiogenesis. Interfering with the cancers blood supply is thought to prevent that cancers ability to grow and spread in the body (metastasize).
- Barlesi F, Park K, Ciardiello F, et al. Primary analysis from OAK, a randomized phase III study comparing atezolizumab with docetaxel in 2L/3L NSCLC. Proceedings from the annual meeting of the 2016 European Society for Medical Oncology (ESOM). (Abstract #LBA44) Oct. 9, 2016.
- Socinski M et al., Atezolizumab for First-Line Treatment of Metastatic non-squamous NSCLC. N Engl J Med. 2018; 378:2288- 2301.
- GLOBOCAN 2018; Lung Cancer: Estimated cancer incidence, mortality and prevalence worldwide. World Health Organization. Available from: http://gco.iarc.fr/today/data/factsheets/cancers/15-Lung-fact-sheet.pdf. Accessed December 2018.
- American Cancer Society; What Is Non-Small Cell Lung Cancer? [Internet]: Available from: https://www.cancer.org/cancer/non-small-cell-lung-cancer/about/what-is-non-small-cell-lung-cancer.html. Accessed December 2018.
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