Extended maintenance.

Top Line: Is there a role for adjuvant immunotherapy in resected NSCLC?

The Study: For patients with resected NSCLC, adjuvant chemo improves overall survival by ~5%. More recently, adjuvant osimertinib improved disease free survival (DFS) for resected, EGFR-mutated lung adenocarcinoma. So where does adjuvant immunotherapy stand? There are many trials asking that question, and IMpower010 is one of the first to report initial results. Over 1200 patients with completely resected (including mediastinal lymph node dissection) stage IB-IIIA NSCLC received adjuvant platinum-based chemotherapy. Just over 1000 (78.5% of those eligible after surgery) went on to complete chemotherapy and then get randomized to observation or atezolizumab for 1 year. The primary endpoint was DFS in 1) those with stage II-IIIA disease with ≥ 1% PD-L1, 2) those with stage II-IIIA regardless of PD-L1, and 3) all patients. Most of those (88%) had stage II-IIIA disease, and 54% of those were  ≥ 1% PD-L1 positive. Among those with PD-L1+ stage II-IIIA disease, atezolizumab significantly improved DFS from 61→ 75% at 24 months and 48 → 60% at 36 months. Among those with stage II-IIIA disease regardless of PD-L1 status, DFS was also improved from 62 → 70% at 24 months and 50→ 56% at 36 months. However, the benefit of atezo was most notable for those with ≥ 50% PD-L1 positivity. In the overall population, the DFS difference wasn’t significant. Overall survival results were not yet mature. 

TBL: Sequencing adjuvant atezolizumab with chemotherapy improves disease free survival in patients with resected stage II-IIIA NSCLC—particularly among those with PD-L1 positive tumors. | Felip, Lancet 2021