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IMpower133

IMpower133 was the first trial in decades to lengthen survival in extensive-stage small-cell lung cancer, by adding immunotherapy to chemotherapy.

Median OS 12.3 vs 10.3 months (HR 0.70); PFS 5.2 vs 4.3 months. Established chemo-immunotherapy as first-line standard (FDA March 2019). The IMbrella A extension reported the first five-year survival data for chemo-immunotherapy in ES-SCLC, with a small tail of long-term survivors in the atezolizumab arm. Benefit was independent of PD-L1 and TMB.

Setting
First-line extensive-stage SCLC: carboplatin-etoposide + atezolizumab vs carboplatin-etoposide + placebo
Phase
Phase 3
Sponsor
Roche
Registry
Headline result
OS 12.3 vs 10.3 months, HR 0.70.
Reported
2018
Enrolled
403
Replication
Replicated by CASPIAN (durvalumab, 2019) and by serplulimab (ASTRUM-005), tislelizumab (RATIONALE-312), adebrelimab and toripalimab trials in China; the class effect is one of the best-replicated in SCLC.

Outcomes

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In plain words
What these results mean for people, not percentages
403 people took part
Overall survivalprimarysurvival endpoint
  • Median 12.3 vs 10.3 months with Atezolizumab + CE compared with Placebo + CE; about 2 months longer for half the group.
  • A median is a midpoint: half the people did better than this and half did worse, so it is not a prediction for any one person.
  • Put another way, the treated group had about 30 percent lower chance of the event at any given time (hazard ratio 0.7, likely range 0.54 to 0.91).
  • Overall survival counts deaths from any cause, so it is the most direct measure of whether a treatment helps people live longer.
Progression-free survivalprimarysurrogate endpoint
  • Median 5.2 vs 4.3 months with Atezolizumab + CE compared with Placebo + CE; about 0.9 months longer for half the group.
  • A median is a midpoint: half the people did better than this and half did worse, so it is not a prediction for any one person.
  • Put another way, the treated group had about 23 percent lower chance of the event at any given time (hazard ratio 0.77, likely range 0.62 to 0.96).
  • This is a surrogate endpoint: it measures the cancer being controlled or absent on scans and tests, which often, but not always, translates into living longer.
Be careful
  • These results apply to the people the trial enrolled: First-line extensive-stage SCLC: carboplatin-etoposide + atezolizumab vs carboplatin-etoposide + placebo. People in a different situation may not see the same effect.

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.

403 participants enrolled.

Overall survivalprimary
HR 0.7 (0.54–0.91) · p = 0.007
Atezolizumab + CE
12.3 mo
Placebo + CE
10.3 mo
Source
Progression-free survivalprimary
HR 0.77 (0.62–0.96)
Atezolizumab + CE
5.2 mo
Placebo + CE
4.3 mo
EndpointArmnValueHR (95% CI)pSource
Overall survivalprimaryAtezolizumab + CE20112.3 months0.7 (0.54–0.91)0.007link
Placebo + CE20210.3 months
Progression-free survivalprimaryAtezolizumab + CE5.2 months0.77 (0.62–0.96)
Placebo + CE4.3 months
Replication
Replicated by CASPIAN (durvalumab, 2019) and by serplulimab (ASTRUM-005), tislelizumab (RATIONALE-312), adebrelimab and toripalimab trials in China; the class effect is one of the best-replicated in SCLC.

Connected

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