{"entity":{"id":"impower110","kind":"trial","name":"IMpower110","aka":[],"tldr":"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.\n\nIn 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.\n\nThe 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.","status":"positive","asOf":"2026-09-25","links":[{"label":"ClinicalTrials.gov NCT02409342","url":"https://clinicaltrials.gov/study/NCT02409342"},{"label":"IMpower110 (New England Journal of Medicine 2020)","url":"https://doi.org/10.1056/NEJMoa1917346"},{"label":"NICE TA705: atezolizumab monotherapy for untreated advanced non-small-cell lung cancer","url":"https://www.nice.org.uk/guidance/ta705"}],"tags":[],"related":[],"cancers":["pdl1-high-nsclc","nsclc"],"sections":[],"technologies":["checkpoint-inhibitor","companion-diagnostic","platinum"],"targets":["pdl1"],"drugs":["atezolizumab","carboplatin","cisplatin"],"companies":["roche-genentech"],"institutions":[],"pathways":[],"terms":["tps","pd-l1-testing","tmb"],"trials":["keynote-024-189","keynote-042","empower-lung-1"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"nct":"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","result":"In the PD-L1-highest subgroup, median overall survival 20.2 against 13.1 months (hazard ratio 0.59, p=0.01).","yearReported":2020,"enrolled":572,"enrolledBasis":"registry","outcomes":[{"endpoint":"Overall survival (highest PD-L1 expression, EGFR and ALK wild-type)","primary":true,"unit":"months","arms":[{"name":"Atezolizumab","value":20.2},{"name":"Platinum-based chemotherapy","value":13.1}],"hr":0.59,"p":"0.01","source":"https://doi.org/10.1056/NEJMoa1917346"}],"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."},"route":"/trials/impower110/","neighbours":{"cancer":[{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","route":"/cancers/lung-cancer/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"},{"id":"pdl1-high-nsclc","kind":"cancer","name":"PD-L1-high non-small-cell lung cancer without a driver mutation","route":"/cancers/pdl1-high-nsclc/"}],"technology":[{"id":"companion-diagnostic","kind":"technology","name":"Companion diagnostics","route":"/technologies/companion-diagnostic/"},{"id":"checkpoint-inhibitor","kind":"technology","name":"Immune checkpoint inhibitors","route":"/technologies/checkpoint-inhibitor/"},{"id":"platinum","kind":"technology","name":"Platinum agents","route":"/technologies/platinum/"}],"target":[{"id":"pdl1","kind":"target","name":"PD-L1","route":"/targets/pdl1/"}],"drug":[{"id":"atezolizumab","kind":"drug","name":"Atezolizumab","route":"/drugs/atezolizumab/"},{"id":"carboplatin","kind":"drug","name":"Carboplatin","route":"/drugs/carboplatin/"},{"id":"cisplatin","kind":"drug","name":"Cisplatin","route":"/drugs/cisplatin/"}],"company":[{"id":"roche-genentech","kind":"company","name":"Roche / Genentech","route":"/companies/roche-genentech/"}],"term":[{"id":"pd-l1-testing","kind":"term","name":"PD-L1 expression testing (22C3, SP142, SP263)","route":"/terms/pd-l1-testing/"},{"id":"tmb","kind":"term","name":"Tumour mutational burden (TMB)","route":"/terms/tmb/"},{"id":"tps","kind":"term","name":"Tumour proportion score (TPS)","route":"/terms/tps/"}],"trial":[{"id":"empower-lung-1","kind":"trial","name":"EMPOWER-Lung 1","route":"/trials/empower-lung-1/"},{"id":"keynote-024-189","kind":"trial","name":"KEYNOTE-024 & KEYNOTE-189","route":"/trials/keynote-024-189/"},{"id":"keynote-042","kind":"trial","name":"KEYNOTE-042","route":"/trials/keynote-042/"}]}}