# IMpower110: atezolizumab for first-line treatment of PD-L1-selected patients with non-small-cell lung cancer

Source: https://onco.cc/key-papers/paper-impower110-atezolizumab-pd-l1-nejm-2020/  
OnCo record `paper-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 patients whose lung cancer had the highest levels of the PD-L1 protein and no targetable mutation, an immunotherapy drug given alone added about seven months of life compared with chemotherapy.

## Summary

Patients with metastatic non-squamous or squamous non-small-cell lung cancer who had not received chemotherapy and whose tumours expressed PD-L1 on at least 1% of tumour cells or at least 1% of tumour-infiltrating immune cells by the SP142 assay were randomly assigned to atezolizumab or platinum-based chemotherapy. Overall survival was tested hierarchically by PD-L1 expression among patients whose tumours were wild-type for EGFR and ALK. Of 572 patients enrolled, in the 205 with the highest PD-L1 expression and wild-type EGFR and ALK, median overall survival was 20.2 months with atezolizumab against 13.1 months with chemotherapy, hazard ratio 0.59. Grade 3 or 4 adverse events occurred in 30.1% with atezolizumab and 52.5% with chemotherapy. Survival also favoured atezolizumab in the subgroups with high blood-based tumour mutational burden.

## Fields

- Kind: Key paper
- Last checked: 2026-09-25
- Journal: New England Journal of Medicine
- Year: 2020
- DOI: 10.1056/NEJMoa1917346
- Authors: Herbst RS, Giaccone G, de Marinis F, et al.
- Findings: Median overall survival 20.2 against 13.1 months in the highest PD-L1 expression group, hazard ratio 0.59.; Selection used the SP142 assay with both tumour-cell and immune-cell scores.; Grade 3 or 4 adverse events 30.1% against 52.5% for chemotherapy.; Blood-based tumour mutational burden subgroups also favoured atezolizumab.
- What it means: It is the reason the SP142 assay and its two-compartment score remain in use despite being the least comparable of the PD-L1 assays: the atezolizumab threshold was defined on it and cannot simply be translated to another stain.
- Caveats: The benefit was confined to the highest expression group; the hierarchical testing stopped there.; Open-label design.; The blood-based burden analysis was a subgroup exploration.

## Sources

- Herbst et al., N Engl J Med 2020: IMpower110, first-line atezolizumab in PD-L1-selected non-small-cell lung cancer (SP142): https://doi.org/10.1056/NEJMoa1917346
- PubMed: https://pubmed.ncbi.nlm.nih.gov/32997907/

## Connected records

- biomarkers: [PD-L1 IC score (immune-cell score, SP142)](https://onco.cc/biomarkers/pd-l1-ic-score/), [PD-L1 TC score (tumour-cell score, SP263 and 28-8)](https://onco.cc/biomarkers/pd-l1-tc-score/), [TMB-high (tumour mutational burden >= 10 mutations per megabase)](https://onco.cc/biomarkers/tmb-high/)
- cancers: [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/)
- technologies: [Histopathology & immunohistochemistry](https://onco.cc/technologies/histopathology-ihc/), [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/)
- targets: [PD-L1](https://onco.cc/targets/pdl1/)
- drugs: [Atezolizumab](https://onco.cc/drugs/atezolizumab/), [VENTANA PD-L1 (SP142) Assay](https://onco.cc/drugs/ventana-pd-l1-sp142/)
- pathways: [PD-1 / PD-L1 immune checkpoint & T-cell activation](https://onco.cc/pathways/pd1-checkpoint/)
- terms: [Immunohistochemistry (IHC)](https://onco.cc/terms/ihc/), [Tumour mutational burden (TMB)](https://onco.cc/terms/tmb/)
- people: [Roy S. Herbst](https://onco.cc/people/roy-herbst/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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