# Atezolizumab for first-line treatment of PD-L1-selected patients with NSCLC

Source: https://onco.cc/key-papers/paper-herbst-impower110-atezolizumab-pd-l1-nejm-2020/  
OnCo record `paper-herbst-impower110-atezolizumab-pd-l1-nejm-2020` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

In the patients whose tumours showed the most PD-L1, immunotherapy alone gave a median survival of 20.2 months against 13.1 on chemotherapy, with far fewer severe side effects.

## Summary

Herbst, Giaccone, de Marinis and colleagues randomised 572 patients with metastatic non-squamous or squamous non-small-cell lung cancer, untreated and with PD-L1 expression on at least 1 percent of tumour cells or tumour-infiltrating immune cells by the SP142 assay, 1 to 1 between atezolizumab and platinum-based chemotherapy. Overall survival was tested hierarchically by PD-L1 status among patients whose tumours were EGFR and ALK wild-type.

IMpower110 is the trial that generalised KEYNOTE-024's result to a second drug and a second assay, and in doing so exposed the assay problem: SP142, 22C3 and SP263 score different things and select different patients, so PD-L1 high means different populations in different trials.

## Fields

- Kind: Key paper
- Last checked: 2026-09-25
- Tags: lung-evidence
- Journal: New England Journal of Medicine
- Year: 2020
- DOI: 10.1056/NEJMoa1917346
- Authors: Herbst RS, Giaccone G, de Marinis F, et al.
- Findings: In EGFR and ALK wild-type patients with the highest PD-L1 expression (205 patients), median overall survival was 20.2 months with atezolizumab against 13.1 months with chemotherapy: hazard ratio for death 0.59 (P equals 0.01).; Adverse events occurred in 90.2 percent of patients on atezolizumab and 94.7 percent on chemotherapy.; Grade 3 or 4 adverse events occurred in 30.1 percent on atezolizumab and 52.5 percent on chemotherapy.; Overall and progression-free survival favoured atezolizumab in the subgroups with high blood-based tumour mutational burden.
- What it means: For the minority of patients whose tumours express a lot of PD-L1, a single antibody outperforms chemotherapy and is far easier to take. The word minority is the point: the same drug in the same disease at lower PD-L1 gives much less.
- Caveats: The headline result is in 205 of 572 enrolled patients, the highest PD-L1 subgroup within the wild-type population; the hierarchical testing stopped there.; SP142 is not interchangeable with the 22C3 assay used in the KEYNOTE trials, so eligibility does not transfer between them.; Blood-based tumour mutational burden was exploratory and has not become a routine selection tool.

## Sources

- N Engl J Med 2020: https://doi.org/10.1056/NEJMoa1917346
- PubMed: https://pubmed.ncbi.nlm.nih.gov/32997907/
- ClinicalTrials.gov NCT02409342: https://clinicaltrials.gov/study/NCT02409342

## Connected records

- key papers: [KEYNOTE-001 (Garon 2015): pembrolizumab in non-small-cell lung cancer and the 50% PD-L1 cut-off](https://onco.cc/key-papers/paper-keynote-001-pembrolizumab-nsclc-nejm-2015/), [KEYNOTE-024: pembrolizumab alone beats chemotherapy in PD-L1-high lung cancer](https://onco.cc/key-papers/paper-keynote-024-nejm-2016/), [Pembrolizumab versus chemotherapy for previously untreated, PD-L1-expressing, locally advanced or metastatic non-small-cell lung cancer (KEYNOTE-042): a randomised, open-label, controlled, phase 3 trial](https://onco.cc/key-papers/paper-keynote-042-lancet-2019/), [Topalian 2012: the first large trial of a PD-1 antibody shows durable responses across melanoma, lung and kidney cancer](https://onco.cc/key-papers/paper-topalian-anti-pd1-nejm-2012/)
- roadmaps: [Immunotherapy roadmap: Coley's toxins → checkpoint inhibitors → engineered immunity](https://onco.cc/roadmaps/immunotherapy-roadmap/), [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/)
- 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/)
- fronts: [Diagnostics & Biomarkers](https://onco.cc/fronts/diagnostics/), [Immunotherapy](https://onco.cc/fronts/immunotherapy/)
- terms: [Immune checkpoint](https://onco.cc/terms/immune-checkpoint/), [Immunohistochemistry (IHC)](https://onco.cc/terms/ihc/), [Tumour mutational burden (TMB)](https://onco.cc/terms/tmb/), [Tumour proportion score (TPS)](https://onco.cc/terms/tps/)
- 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/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/)
- companies: [Roche / Genentech](https://onco.cc/companies/roche-genentech/)
- people: [Roy S. Herbst](https://onco.cc/people/roy-herbst/)
- bottlenecks: [Biomarkers are not validated or standardised](https://onco.cc/bottlenecks/b-biomarker-validation/), [No one can predict who responds to immunotherapy](https://onco.cc/bottlenecks/b-immunotherapy-response/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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