Tecentriq Immunotherapy Treatment of Breast Cancer
by Dr. C.H. Weaver M.D. updated 9/2020
The US Food and Drug Administration granted accelerated approval to Tecentriq (atezolizumzb) in combination with Abraxane (nab-paclitaxel) for the first-line treatment of unresectable locally advanced or metastatic triple-negative breast cancer. (TNBC).
The combination of Tecentriq immunotherapy and chemotherapy improved survival of women with TNBC as evidenced by the results from the IMpassion 130 clinical trial which were shared at the European Society for Medical Oncology (ESMO) 2018 Congress, published in the New England Journal of Medicine, and updated at the American Society of Clinical Oncology ASCO) meeting in June 2019.(1-3) The results of the IMpassion131 clinical trail released in August 2020 however were disappointing - Tecentriq when combined with paclitaxel was no better than paclitaxel alone. (5) The FDA alerted health care professionals and oncology researchers that paclitaxel did not significantly reduce the risk for cancer progression or death among PD-L1-positive patients with previously untreated inoperable locally advanced or metastatic triple-negative breast cancer. Health care professionals should not replace nab-paclitaxel with paclitaxel in clinical practice, according to the alert.
About Tecentriq (atezolizumab)
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 enables the activation of T cells, restoring their ability to effectively detect and attack cancer cells.
Over 900 women with previously untreated advanced TNBC were enrolled on the IMpassion130 clinical trial and treated with Nab Paclitaxel chemotherapy with or without Tecentriq immunotherapy and directly compared.(1)
Overall the addition of Tecentriq improved the “progression free survival” by 20%. When the researchers looked at a subgroup of patients who were PD-L1+, the addition of Tecentriq improved PFS by 38% and increased overall survival by the same percentage, offering patients an additional 10 months of life over those who received chemotherapy alone.
ASCO 2019 Update Confirms Tecentriq Benefit in Advanced TNBC
Findings from the 2nd interim analyses were presented at the 2019 ASCO Annual Meeting and confirmed the clinically meaningful overall survival benefit for Tecentriq plus nab-paclitaxel in treatment-naïve patients with PD-L1–positive, metastatic triple-negative breast cancer.
Dr Schmid and his co-investigators confirmed there is a 10 month improvement in the average overall survival in PD-L1–positive patients. In 451 women with metastatic TNBC and PD-L1–positive cancers, the median overall survival was 25 months among patients with PD-L1–positive tumors compared to 15.5 months for treatment with Nab Paclitaxel alone.(2,3)
Other studies have suggested that PD-L1 may be a suitable target in TNBC as the protein can inhibit anti-cancer immune responses and it is expressed on tumor-infiltrating immune cells in patients with the disease.
IMpassion131 Clinicl Trial Fails to Improve Outcomes in Earlier Stage Disease
The IMpassion131 clinical trial compared Tecentriq in combination with paclitaxel, in to placebo plus paclitaxel, in people with previously untreated, inoperable, locally advanced or metastatic TNBC. The study enrolled 651 people who were randomised in a 2:1 ratio to receive Tecentriq or placebo plus paclitaxel. Tecentriq did not delay cancer progression or improve survival when add to paclitaxel when compared to paclitaxel alone when used as the initial treatment of people TNBC who were PD-L1-positive. (5)
According to the study authors in order “to improve the results of IMpassion130 further, the patient population needs to be better selected for those who are likely to benefit from immunotherapy the most. This means not just looking at PD-L1 expression, but also surrogates of immune response, tumor mutation burden, and microsatellite instability status, all of which have been observed to be altered in triple negative breast cancer patients.”
Stay Current - Connect With Other Triple-Negative Breast Cancer Patients
- European Society for Medical Oncology (ESMO) 2018 Congress. Presented October 20, 2018. Abstract LBA1.
- N Engl J Med. Published on October 20, 2018. Abstract
- Schmid P, Adams S, Rugo HS, et al. IMpassion130: updated overall survival (OS) from a global, randomized, double-blind, placebo-controlled, Phase III study of atezolizumab (atezo) + nab-paclitaxel (nP) in previously untreated locally advanced or metastatic triple-negative breast cancer (mTNBC). Presented at: the 2019 ASCO Annual Meeting; May 31-June 4, 2019; Chicago, IL. Abstract 1003.
- Atezolizumab and Nab-Paclitaxel
in Advanced Triple-Negative Breast Cancer
- Roche provides update on Phase III study of Tecentriq in combination with paclitaxel for people with metastatic triple-negative breast cancer