Roche Immunotherapy Combination Increases Lung Cancer Survival – Study

One thought on “Roche Immunotherapy Combination Increases Lung Cancer Survival – Study

  1. It looks like we’re going to have data from the IMpower150 trial released in small bits every few months, without any new electrifying developments. Here, the most notable finding is the hazard ratio for OS of 0.54 among patients with an EGFR mutation or ALK rearrangement who received carbo/paclitaxel/bevacizumab + atezolizumab, compared to carbo/pac/bev alone. Patients with liver mets also had the same HR for OS of 0.54 with chemo/bev/atezo.

    The reality is that the real comparator for the IMpower150 four-drug regimen is carbo/pemetrexed/pembro (as per KEYNOTE-189), and I think for a broad population, the KEYNOTE-189 regimen is more compelling. However, for patients with an EGFR mutation especially, and to a lesser extent those with an ALK rearrangement, the carbo/pac/bev/atezo regimen deserves to be considered as a compelling option AFTER patients have progressed on initial targeted therapy. Importantly, these patients were to have already received an EGFR or ALK TKI, and the IMpower150 approach should not replace highly effective targeted therapy as first line treatment.

    We should expect to see far more work on immunotherapy in patients with a driver mutation. One of the most significant effects of IMpower150 will be that it leads to a re-opening of this question, after the data we had in 2nd line NSCLC led most lung cancer specialists to conclude that checkpoint inhibitors don’t have meaningful activity in these patients.

    Finally, we need to clarify if the benefit requires bevacizumab, which can be answered by seeing how Arm A of IMpower150 (carbo/pac/atezo, no bev) does. That hasn’t been reported yet but can help us understand the contribution of the bev component on Arm B.

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