The following is a summary of “Phase II Randomized Trial of Carboplatin, Pemetrexed, and Bevacizumab With and Without Atezolizumab in Stage IV Nonsquamous Non–Small-Cell Lung Cancer Patients Who Harbor a Sensitizing EGFR Mutation or Have Never Smoked,” published in the November 2023 issue of Pulmonology by Bodor, et al.

Single-agent PD-1/PD-L1 checkpoint drugs don’t help people with non-small-cell lung cancer (NSCLC) who have never smoked or whose tumors have EGFR mutations very much. Earlier research suggested that blocking PD-L1 along with anti-VEGF and cytotoxic treatment may be a good way to help these people who are resistant to immunotherapy, but this needed to be confirmed in a real-life setting. 

For a study, researchers sought to look at people with stage IV NSCLC who have never smoked or whose tumors have changes that make them more sensitive to EGFR to see if a 4-drug combination of atezolizumab, carboplatin, pemetrexed, and bevacizumab can improve outcomes compared to carboplatin, pemetrexed, and bevacizumab without atezolizumab. There are 117 people with stage IV nonsquamous NSCLC in the randomized, phase II, international study that looks at carboplatin, pemetrexed, and bevacizumab with and without atezolizumab. Randomization gives the arm with atezolizumab a 2:1 advantage. Patients who meet the requirements are those whose cancers have changes in exons 19 or 21 that make them more sensitive to EGFR or people who have never smoked and whose cancers are “wild-type,” which means they don’t have any changes to EGFR, ALK, or ROS1.

If a patient has smoked less than 100 cigarettes in their whole life, they are considered to have never smoked. Patients with EGFR-mutated cancers must have had their disease get worse or not been able to handle previous tyrosine kinase inhibitor (TKI) treatment. The main goal was progression-free survival (PFS). Overall survival (OS), response rate, response length, and time to reaction are some secondary goals. The National Comprehensive Cancer Network (NCCN) is helping to find people for this phase II study at places in the United States. In August 2019, the trial began, and the last person will be added in the fall of 2024.

Source: sciencedirect.com/science/article/abs/pii/S1525730423000979