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13-09-2021 | Oncology | News | Article

WCLC 2021

Atezolizumab plus chemotherapy feasible for NSCLC with brain metastases

Laura Cowen

medwireNews: Treatment with carboplatin and pemetrexed plus atezolizumab shows promise for people with nonsquamous non-small-cell lung cancer (NSCLC) and asymptomatic, untreated brain metastases, phase 2 study findings indicate.

The results of the ATEZO-BRAIN trial were presented at the IASLC 2021 World Conference on Lung Cancer by Ernest Nadal from the Institut Català d’Oncologia – L’Hospitalet in Barcelona, Spain.

He explained that people “with untreated brain metastases […] have been excluded or underrepresented in clinical trials evaluating chemotherapy plus immunotherapy in the first line setting.”

To address this, Nadal and team recruited 40 chemotherapy-naïve patients (median age 62.5 years, 72.5% men) with stage IV nonsquamous NSCLC without EGFR or ALK mutations and asymptomatic untreated brain metastases. Of these, 42.5% were receiving dexamethasone ≤4 mg/day at baseline.

The patients were given atezolizumab 1200 mg plus carboplatin (5 AUCs) and pemetrexed 500 mg/m2 every 3 weeks for four to six cycles, followed by pemetrexed plus atezolizumab maintenance until disease progression, unacceptable toxicity, or 2 years.

The study was permitted to continue after 12 weeks when the progression-free survival (PFS) rate was calculated to be at least 50% and the maximum rate of grade 3–4 toxicity was below 35%, as specified using historical data for chemotherapy alone, the presenter explained.

Nadal reported that, after a median 17.3 months of follow up, the intracranial objective response rate (ORR) was 40.0%, including four (10.0%) complete responses, while the systemic ORR was 47.4%, all of which were partial responses.

He added that just four patients had discordant central nervous system and systemic responses: two had stable disease in the brain and progressive disease in the body, and two had progressive disease in the brain and a partial response in the body.

The co-primary endpoint of PFS was a median 6.8 months for intracranial disease and 8.9 months for systemic disease, with corresponding 18-month PFS rates of 24.9% and 10.4%. Median overall survival was 13.6 months and 32.0% of participants were still alive at 2 years.

In terms of the second co-primary endpoint of safety, Nadal told delegates that the majority of treatment-related adverse events (TRAEs) were of grade 1 or 2 in severity. Grade 3 or 4 events were observed in 27.5% of patients and were most commonly anemia (20.0%), back pain (10.0%), and thrombocytopenia (5.0%). There were no grade 5 TRAEs but three patients (7.5%) experienced a grade 4 event (thrombocytopenia, neutropenia, and hallucinations).

Nadal concluded: “The safety profile and efficacy of atezolizumab combined with carboplatin and pemetrexed is favorable in patients with NSCLC and untreated brain metastases, including those receiving corticoids.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group

IASLC 2021 World Conference on Lung Cancer; 8–14 September

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