{"entity":{"id":"paper-felip-impower010-adjuvant-atezolizumab-lancet-2021","kind":"paper","name":"Adjuvant atezolizumab after adjuvant chemotherapy in resected stage IB-IIIA non-small-cell lung cancer (IMpower010)","aka":[],"tldr":"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.\n\nThe 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.","asOf":"2026-09-25","links":[{"label":"Lancet 2021","url":"https://doi.org/10.1016/S0140-6736(21)02098-5"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/34555333/"},{"label":"ClinicalTrials.gov NCT02486718","url":"https://clinicaltrials.gov/study/NCT02486718"}],"tags":["lung-evidence"],"related":["paper-lace-adjuvant-cisplatin-pooled-analysis-jco-2008","paper-checkmate-816-nejm-2022","paper-heymach-aegean-perioperative-durvalumab-nejm-2023","paper-keynote-671-n-engl-j-med-2023"],"cancers":["lung-cancer","nsclc","resectable-nsclc","pdl1-high-nsclc"],"sections":["immunotherapy","surgery"],"technologies":["ihc","checkpoint-inhibitor"],"targets":["pd1"],"drugs":["atezolizumab","cisplatin","carboplatin"],"companies":["roche-genentech"],"institutions":[],"pathways":["immune-checkpoint"],"terms":["neoadjuvant-adjuvant","pdl1"],"trials":[],"people":[],"bottlenecks":["b-dormancy-mrd","b-immunotherapy-response","b-biomarker-validation"],"keyPapers":[],"journals":["lancet"],"dependsOn":[],"notes":[],"journal":"The Lancet","year":2021,"doi":"10.1016/S0140-6736(21)02098-5","pmid":"34555333","authors":"Felip E, Altorki N, Zhou C, et al.","paperType":"rct","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)."],"whatItMeans":"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."],"changedPractice":true,"participants":1005},"route":"/key-papers/paper-felip-impower010-adjuvant-atezolizumab-lancet-2021/","neighbours":{"paper":[{"id":"paper-checkmate-816-nejm-2022","kind":"paper","name":"CheckMate 816: three cycles of nivolumab plus chemotherapy before lung cancer surgery","route":"/key-papers/paper-checkmate-816-nejm-2022/"},{"id":"paper-lace-adjuvant-cisplatin-pooled-analysis-jco-2008","kind":"paper","name":"Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group","route":"/key-papers/paper-lace-adjuvant-cisplatin-pooled-analysis-jco-2008/"},{"id":"paper-heymach-aegean-perioperative-durvalumab-nejm-2023","kind":"paper","name":"Perioperative durvalumab for resectable non-small-cell lung cancer","route":"/key-papers/paper-heymach-aegean-perioperative-durvalumab-nejm-2023/"},{"id":"paper-keynote-671-n-engl-j-med-2023","kind":"paper","name":"Perioperative Pembrolizumab for Early-Stage Non-Small-Cell Lung Cancer","route":"/key-papers/paper-keynote-671-n-engl-j-med-2023/"}],"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/"},{"id":"resectable-nsclc","kind":"cancer","name":"Resectable stage I to III non-small-cell lung cancer","route":"/cancers/resectable-nsclc/"}],"section":[{"id":"immunotherapy","kind":"section","name":"Immunotherapy","route":"/fronts/immunotherapy/"},{"id":"surgery","kind":"section","name":"Surgery & Interventional","route":"/fronts/surgery/"}],"term":[{"id":"immune-checkpoint","kind":"term","name":"Immune checkpoint","route":"/terms/immune-checkpoint/"},{"id":"ihc","kind":"term","name":"Immunohistochemistry (IHC)","route":"/terms/ihc/"},{"id":"neoadjuvant-adjuvant","kind":"term","name":"Neoadjuvant / adjuvant / perioperative","route":"/terms/neoadjuvant-adjuvant/"}],"technology":[{"id":"checkpoint-inhibitor","kind":"technology","name":"Immune checkpoint inhibitors","route":"/technologies/checkpoint-inhibitor/"}],"target":[{"id":"pd1","kind":"target","name":"PD-1","route":"/targets/pd1/"},{"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/"}],"bottleneck":[{"id":"b-biomarker-validation","kind":"bottleneck","name":"Biomarkers are not validated or standardised","route":"/bottlenecks/b-biomarker-validation/"},{"id":"b-dormancy-mrd","kind":"bottleneck","name":"Dormant cells and minimal residual disease","route":"/bottlenecks/b-dormancy-mrd/"},{"id":"b-immunotherapy-response","kind":"bottleneck","name":"No one can predict who responds to immunotherapy","route":"/bottlenecks/b-immunotherapy-response/"}],"journal":[{"id":"lancet","kind":"journal","name":"The Lancet","route":"/journals/lancet/"}],"roadmap":[{"id":"lung-cancer-evidence-roadmap","kind":"roadmap","name":"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","route":"/roadmaps/lung-cancer-evidence-roadmap/"}]}}