VIENNA, AUSTRIA—Atezolizumab may substantially change treatment strategies for patients with refractory lung cancer, according the first efficacy results from the POPLAR and BIRCH studies, which studied atezolizumab across treatment lines. The results were presented at the European Cancer Congress 2015 (ECC2015).

“In the BIRCH trial the PD-L1 antibody atezolizumab showed a remarkable activity in a large number of patients regardless of the line of treatment,” said Martin Reck, MD, PhD, chief oncology physician in the Department of Thoracic Oncology at the Hospital Grosshansdorf in Germany. “The profile of adverse events is in line with reported data from other PD-1/PD-L1 checkpoint inhibitors and overall tolerability looks quite favorable. The efficacy as shown by the response rate was in correlation with PD-L1 expression on tumor and immune cells favoring tumors with high PD-L1 expression.”

“In confirmation the randomized POPLAR trial reported a superior overall survival for unselected patients who received atezolizumab as second-line treatment compared to docetaxel,” continued Reck. “Again efficacy could be correlated to the PD-L1 expression status with the highest overall survival benefit in patients with TC3 and IC3 (high PD-L1 expressing tumors). The data have to be validated by a large randomized phase III trial, which is ongoing.”

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Commenting on how atezolizumab compares with current therapies for lung cancer, Reck said: “Atezolizumab is the second checkpoint inhibitor to show a superior efficacy and better tolerability compared to standard second-line chemotherapy in patients with pretreated non-small cell lung cancer (NSCLC). Therefore it is to be expected that atezolizumab, like other PD-1 and PD-L1 antibodies, will substantially change treatment strategies of patients with refractory lung cancer.”

“First-line treatment with atezolizumab in patients with PD-L1 high expressing tumors or the combination of atezolizumab with platinum-based chemotherapy remains an attractive option and is currently being investigated in large randomized phase III trials,” said Reck. Activity is also seen in small cell lung cancer (SCLC) and mesothelioma. These will be explored in future trials, he explains.

It is expected that pretreatment of patients will change dramatically based on the findings from POPLAR and BIRCH and other reported data with the PD-1 antibody nivolumab, which was recently approved by the European Medicines Agency (EMA) for the treatment of patients with refractory squamous cell NSCLC. The FDA approved nivolumab for use in the United States for advanced metastatic squamous NSCLC in March 2015.

“In particular, the option for long-lasting responses and stabilization in combination with an attractive tolerability profile will impact clinical practice,” said Reck. “Whether patients should be selected using a biomarker strategy still needs to be determined and remains a significant challenge based on the multiple different companion diagnostics that are in use for the particular agents. Depending on the results of ongoing trials front-line treatment with a checkpoint inhibitor in selected patients could be an interesting option.”