# IMpower110

Source: https://onco.cc/trials/impower110/  
OnCo record `impower110` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Showed that for people whose tumours are covered in PD-L1, a single immunotherapy drug can replace first-line chemotherapy, adding about seven months of life.

## Summary

IMpower110 enrolled 572 patients with untreated metastatic non-small-cell lung cancer of either histology whose tumours expressed PD-L1 on at least 1 percent of tumour cells or tumour-infiltrating immune cells by the SP142 assay, and randomised them 1:1 to atezolizumab alone or to platinum-based chemotherapy. Overall survival was tested hierarchically by PD-L1 expression level within the EGFR and ALK wild-type population.

In the 205 patients with the highest PD-L1 expression, median overall survival was 20.2 months with atezolizumab against 13.1 months with chemotherapy, a 7.1-month difference (hazard ratio for death 0.59, p=0.01), regardless of histological type. Adverse events occurred in 90.2 percent on atezolizumab and 94.7 percent on chemotherapy, with grade 3 or 4 events in 30.1 and 52.5 percent: the toxicity argument for single-agent immunotherapy is as strong as the efficacy one. Blood-based tumour mutational burden also selected patients who did better.

The FDA approved atezolizumab as first-line monotherapy for high PD-L1 expression in 2020. In England NICE TA705 (2 June 2021) recommends atezolizumab monotherapy for untreated advanced disease. The trial also illustrated the assay problem: SP142 scores differently from the 22C3 assay used in KEYNOTE-024, so a patient can be PD-L1-high for one drug and not for another.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-09-25
- Registry id: NCT02409342
- Phase: 3
- Setting: Untreated metastatic non-squamous or squamous non-small-cell lung cancer with PD-L1 on at least 1 percent of tumour cells or tumour-infiltrating immune cells by the SP142 assay: atezolizumab alone versus platinum-based chemotherapy, with overall survival tested hierarchically by PD-L1 level in the EGFR and ALK wild-type population
- Sponsor: Roche
- Enrolled: 572
- Result: In the PD-L1-highest subgroup, median overall survival 20.2 against 13.1 months (hazard ratio 0.59, p=0.01).
- Outcomes: Overall survival (highest PD-L1 expression, EGFR and ALK wild-type): Atezolizumab 20.2 months vs Platinum-based chemotherapy 13.1 months, HR 0.59
- Replication: KEYNOTE-024 and EMPOWER-Lung 1 showed the same with pembrolizumab and cemiplimab in PD-L1-high disease; KEYNOTE-042 extended it, weakly, to PD-L1 1 percent or more.

## Sources

- ClinicalTrials.gov NCT02409342: https://clinicaltrials.gov/study/NCT02409342
- IMpower110 (New England Journal of Medicine 2020): https://doi.org/10.1056/NEJMoa1917346
- NICE TA705: atezolizumab monotherapy for untreated advanced non-small-cell lung cancer: https://www.nice.org.uk/guidance/ta705

## Connected records

- cancers: [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [PD-L1-high non-small-cell lung cancer without a driver mutation](https://onco.cc/cancers/pdl1-high-nsclc/)
- technologies: [Companion diagnostics](https://onco.cc/technologies/companion-diagnostic/), [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/), [Platinum agents](https://onco.cc/technologies/platinum/)
- targets: [PD-L1](https://onco.cc/targets/pdl1/)
- drugs: [Atezolizumab](https://onco.cc/drugs/atezolizumab/), [Carboplatin](https://onco.cc/drugs/carboplatin/), [Cisplatin](https://onco.cc/drugs/cisplatin/)
- companies: [Roche / Genentech](https://onco.cc/companies/roche-genentech/)
- terms: [PD-L1 expression testing (22C3, SP142, SP263)](https://onco.cc/terms/pd-l1-testing/), [Tumour mutational burden (TMB)](https://onco.cc/terms/tmb/), [Tumour proportion score (TPS)](https://onco.cc/terms/tps/)
- trials: [EMPOWER-Lung 1](https://onco.cc/trials/empower-lung-1/), [KEYNOTE-024 & KEYNOTE-189](https://onco.cc/trials/keynote-024-189/), [KEYNOTE-042](https://onco.cc/trials/keynote-042/)

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