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Phase III IMpower130 Study Showed Roche’s Tecentriq (Atezolizumab) Plus Chemotherapy (Carboplatin And Abraxane) Helped People With Metastatic Non-squamous NSCLC Live Significantly Longer Compared To Chemotherapy Alone

(Roche) May 29, 2018 - Roche today announced that the Phase III IMpower130 study met its co-primary endpoints of overall survival (OS) and progression-free survival (PFS).

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H. Jack West, MD (Posted: May 29, 2018)

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Important trial result, positive for both PFS & OS benefit, that confirms benefit of first line chemo-immunotherapy, here with atezolizumab added to carbo/nab-paclitaxel in patients with advanced non-squamous NSCLC, is not specific to a particular chemo backbone or immune checkpoint inhibitor. Instead, it's looking more and more like relatively comparable results will be seen in multiple trials, and we'll have a choice of chemo doublets paired with checkpoint inhibitors.

In that setting, people will gravitate to the chemo regimens they prefer in this setting, and in the US, I think carbo/pemetrexed will be favored for most patients with advanced non-squamous NSCLC. I think with KEYNOTE-021g regimen of carbo/pemetrexed/pembro already FDA approved and KEYNOTE-189 looking so impressive, this will be the default regimen. This means that any new chemo/immunotherapy combination will be reviewed in the context of whether it provides a meaningful incremental benefit over carbo/pem/pembro. I don't think carbo/nab-paclitaxel/atezolizumab can be said to be anything more than a lateral move at best.

The only real caveat I'd offer is the possibility that the story of steroid treatment with chemo/immunotherapy or immunotherapy alone may detract from the benefit of immunotherapy, which some retrospective work has indicated, though the 3 days of premedication with pemetrexed likely wouldn't register as enough to undermine the benefit of immunotherapy, and certainly the highly positive results of the KEYNOTE-189 trial argue against that.

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