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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.
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.
In 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.
The 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.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
572 enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Overall survival (highest PD-L1 expression, EGFR and ALK wild-type)primary | Atezolizumab | - | 20.2 months | 0.59 | 0.01 | link |
| Platinum-based chemotherapy | - | 13.1 months |
Shares KEYNOTE-024 & KEYNOTE-189, Tumour proportion score (TPS), PD-L1 expression testing (22C3, SP142, SP263), PD-L1-high non-small-cell lung cancer without a driver mutation.
Shares KEYNOTE-024 & KEYNOTE-189, Tumour proportion score (TPS), PD-L1 expression testing (22C3, SP142, SP263), PD-L1-high non-small-cell lung cancer without a driver mutation.
Shares KEYNOTE-024 & KEYNOTE-189, Atezolizumab, Roche / Genentech, PD-L1.
Shares Tumour proportion score (TPS), Tumour mutational burden (TMB), PD-L1-high non-small-cell lung cancer without a driver mutation, Atezolizumab.
Shares KEYNOTE-024 & KEYNOTE-189, Tumour proportion score (TPS), PD-L1-high non-small-cell lung cancer without a driver mutation, Immune checkpoint inhibitors.
Shares PD-L1-high non-small-cell lung cancer without a driver mutation, Atezolizumab, Roche / Genentech, Immune checkpoint inhibitors.
Shares PD-L1 expression testing (22C3, SP142, SP263), Atezolizumab, Roche / Genentech, PD-L1.
Shares PD-L1-high non-small-cell lung cancer without a driver mutation, Atezolizumab, Roche / Genentech, PD-L1.