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Added an anti-VEGF antibody to chemotherapy and immunotherapy, and is the one first-line regimen with evidence in people whose cancer is driven by an EGFR or ALK change.
IMpower150 had three arms: atezolizumab with carboplatin and paclitaxel, bevacizumab with carboplatin and paclitaxel, and atezolizumab with bevacizumab, carboplatin and paclitaxel, each for four or six cycles followed by maintenance. The comparison that mattered was the four-drug arm against the bevacizumab arm, tested first, in the EGFR and ALK wild-type population, where 356 and 336 patients were assigned.
Median progression-free survival was 8.3 months with the four-drug regimen against 6.8 months (hazard ratio for progression or death 0.62, 95 percent confidence interval 0.52 to 0.74), and overall survival was also significantly improved, regardless of PD-L1 expression or effector T-cell signature.
IMpower150 is quoted most often for something outside its primary analysis: its exploratory subgroup of patients with EGFR or ALK alterations who had progressed on targeted therapy did appear to benefit, which is why the four-drug regimen is still considered there when nothing else applies, and why the argument persists, since the subgroup is small and the finding exploratory. The FDA approved the regimen in 2018. In England NICE TA584 (5 June 2019) recommends atezolizumab in combination for metastatic non-squamous disease.
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.
1,202 randomised.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Progression-free survival (EGFR and ALK wild-type)primary | Atezolizumab, bevacizumab, carboplatin and paclitaxel | 356 | 8.3 months | 0.62 (0.52 to 0.74) | - | link |
| Bevacizumab, carboplatin and paclitaxel | 336 | 6.8 months |
Shares Immune checkpoint, Adenocarcinoma of the lung, Atezolizumab, Roche / Genentech.
Shares Atezolizumab, Paclitaxel / nab-paclitaxel, Platinum agents, Carboplatin.
Shares KEYNOTE-024 & KEYNOTE-189, Atezolizumab, Roche / Genentech, PD-L1.
Shares VEGF / VEGFR, Atezolizumab, Roche / Genentech, PD-L1.
Shares Immune checkpoint, Adenocarcinoma of the lung, Paclitaxel / nab-paclitaxel, Platinum agents.
Shares Atezolizumab, Roche / Genentech, Bevacizumab, Anti-angiogenic therapy.
Shares Immune checkpoint, Adenocarcinoma of the lung, PD-L1, Lung cancer (all types).
Shares KEYNOTE-024 & KEYNOTE-189, Immune checkpoint, PD-L1, Lung cancer (all types).