A bit of atez.

Top Line: Pilot data demonstrates promising pathologic responses to neoadjuvant immunotherapy for resectable non-small cell lung cancer (NSCLC).

The Study: Remember, adjuvant platinum-based chemotherapy improves overall survival in patients with resected stage II and III NSCLC. And despite higher rates of chemo completion, survival with neoadjuvant chemo is similar to adjuvant therapy. Conspicuously absent here is immunotherapy. In this phase 2 trial, atezolizumab was added to 4 cycles of neoadjuvant carboplatin and nab-paclitaxel for patients with stage IB-IIIA NSCLC regardless of PD-L1 status. Most of the 30 patients had adenocarcinoma (57%) and stage IIIA disease (77%) and were PD-L1+ (55%) and current or former smokers (100%). All but one patient went for surgery and 87% had an R0 resection. Over half of patients (57%) had a major pathologic response, which was defined as 10% or less residual viable tumor. This included a sizable proportion of patients (33%) who had a complete pathologic response. In addition, a post-hoc analysis showed that 58% of patients with confirmed N2 disease were downstaged to pN0. These numbers are encouraging in comparison to the pCR rate with both standard chemo and mono-immunotherapy.

TBL: Adding immunotherapy to neoadjuvant chemotherapy for resectable NSCLC results in encouraging rates of major pathologic response. | Shu, Lancet Oncol 2020