# Adjuvant atezolizumab after adjuvant chemotherapy in resected stage IB-IIIA non-small-cell lung cancer (IMpower010)

Source: https://onco.cc/key-papers/paper-felip-impower010-adjuvant-atezolizumab-lancet-2021/  
OnCo record `paper-felip-impower010-adjuvant-atezolizumab-lancet-2021` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The first trial to show that immunotherapy after lung cancer surgery delays recurrence. The benefit was concentrated in patients whose tumours expressed PD-L1.

## Summary

The IMpower010 investigators, reported by Felip, Altorki, Zhou and colleagues with Wakelee as senior author, randomised 1,005 of 1,280 enrolled patients with completely resected stage IB (tumours 4 cm or larger) to IIIA non-small-cell lung cancer, after one to four cycles of adjuvant platinum chemotherapy, to atezolizumab 1200 mg every 21 days for 16 cycles or a year (507) or best supportive care (498), across 227 sites in 22 countries.

The hierarchical testing order is the result. The PD-L1-positive stage II to IIIA group cleared the bar comfortably, the whole stage II to IIIA group marginally, and the intention-to-treat population barely, which is why regulators restricted the indication to PD-L1-positive stage II to IIIA disease rather than granting what the trial nominally showed.

## Fields

- Kind: Key paper
- Last checked: 2026-09-25
- Tags: lung-evidence
- Journal: The Lancet
- Year: 2021
- DOI: 10.1016/S0140-6736(21)02098-5
- Authors: Felip E, Altorki N, Zhou C, et al.
- Findings: Stage II to IIIA patients whose tumours expressed PD-L1 on 1 percent or more of tumour cells: disease-free survival hazard ratio 0.66 (95 percent confidence interval 0.50 to 0.88; p equals 0.0039).; All stage II to IIIA patients: hazard ratio 0.79 (0.64 to 0.96; p equals 0.020).; Intention-to-treat population (stage IB to IIIA): hazard ratio 0.81 (0.67 to 0.99; p equals 0.040).; Median follow-up 32.2 months in the stage II to IIIA population.; Atezolizumab-related grade 3 and 4 adverse events in 53 of 495 patients (11 percent) and grade 5 events in 4 patients (1 percent).
- What it means: Adjuvant immunotherapy entered lung cancer here, and with it the question that still divides practice: whether it is better given before the operation, after it, or on both sides.
- Caveats: Disease-free survival, with overall survival immature at this report; treatment-related deaths occurred in 1 percent.; Best supportive care rather than placebo, in an open-label trial where recurrence detection depends on scan frequency.; Everyone had already received adjuvant chemotherapy, so it does not say what atezolizumab does on its own.

## Sources

- Lancet 2021: https://doi.org/10.1016/S0140-6736(21)02098-5
- PubMed: https://pubmed.ncbi.nlm.nih.gov/34555333/
- ClinicalTrials.gov NCT02486718: https://clinicaltrials.gov/study/NCT02486718

## Connected records

- key papers: [CheckMate 816: three cycles of nivolumab plus chemotherapy before lung cancer surgery](https://onco.cc/key-papers/paper-checkmate-816-nejm-2022/), [Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group](https://onco.cc/key-papers/paper-lace-adjuvant-cisplatin-pooled-analysis-jco-2008/), [Perioperative durvalumab for resectable non-small-cell lung cancer](https://onco.cc/key-papers/paper-heymach-aegean-perioperative-durvalumab-nejm-2023/), [Perioperative Pembrolizumab for Early-Stage Non-Small-Cell Lung Cancer](https://onco.cc/key-papers/paper-keynote-671-n-engl-j-med-2023/)
- 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/), [Resectable stage I to III non-small-cell lung cancer](https://onco.cc/cancers/resectable-nsclc/)
- fronts: [Immunotherapy](https://onco.cc/fronts/immunotherapy/), [Surgery & Interventional](https://onco.cc/fronts/surgery/)
- terms: [Immune checkpoint](https://onco.cc/terms/immune-checkpoint/), [Immunohistochemistry (IHC)](https://onco.cc/terms/ihc/), [Neoadjuvant / adjuvant / perioperative](https://onco.cc/terms/neoadjuvant-adjuvant/)
- technologies: [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/)
- targets: [PD-1](https://onco.cc/targets/pd1/), [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/)
- bottlenecks: [Biomarkers are not validated or standardised](https://onco.cc/bottlenecks/b-biomarker-validation/), [Dormant cells and minimal residual disease](https://onco.cc/bottlenecks/b-dormancy-mrd/), [No one can predict who responds to immunotherapy](https://onco.cc/bottlenecks/b-immunotherapy-response/)
- journals: [The Lancet](https://onco.cc/journals/lancet/)
- roadmaps: [Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch](https://onco.cc/roadmaps/lung-cancer-evidence-roadmap/)

---
JSON: https://onco.cc/api/v1/entities/paper-felip-impower010-adjuvant-atezolizumab-lancet-2021.json