Pooled analyses of immune-related adverse events (irAEs) and efficacy from the phase 3 trials IMpower130, IMpower132, and IMpower150.

Authors

null

Mark A. Socinski

AdventHealth Cancer Institute, Orlando, FL

Mark A. Socinski , Robert M. Jotte , Federico Cappuzzo , Makoto Nishio , Tony S. K. Mok , Martin Reck , Gene Grant Finley , Wei Yu , Hina Patel , Nindhana Paranthaman , Ilze Bara , Howard West

Organizations

AdventHealth Cancer Institute, Orlando, FL, U.S. Oncology Research/Rocky Mountain Cancer Centers, Lone Tree, CO, Istituto Nazionale Tumori "Regina Elena", Rome, Italy, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan, State Key Laboratory of Translational Oncology, Chinese University of Hong Kong, Hong Kong, China, Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany, Allegheny Health Network Cancer Institute, Pittsburgh, PA, Genentech, Inc., South San Francisco, CA, City of Hope Comprehensive Cancer Center, Duarte, CA

Research Funding

Pharmaceutical/Biotech Company
F. Hoffmann-La Roche, Ltd

Background: PD-L1/PD-1 inhibitors have transformed the treatment (tx) of advanced NSCLC. Evidence suggests that the occurrence of irAEs with these agents may predict improved outcomes in cancers such as NSCLC. Atezolizumab (atezo; anti–PD-L1) has shown efficacy and tolerability in NSCLC and is currently approved in the 1L and 2L+ settings. The Ph 3 IMpower130, IMpower132 and IMpower150 trials evaluated atezo + chemo ± bevacizumab (bev) as 1L tx of NSCLC. We explore the association between irAEs and efficacy in these trials. Methods: Each trial enrolled tx-naive patients (pts) with nonsquamous stage IV NSCLC. Pts were randomized to: carboplatin (carbo) + nab-paclitaxel alone or with atezo in IMpower130; carbo or cisplatin alone or with atezo in IMpower132; atezo (A) + bev (B) + carbo + paclitaxel (CP), ACP or BCP in IMpower150. Data were pooled (data cutoffs: Mar 15 2018 [IMpower130]; May 22 2018 [IMpower132]; Sep 13 2019 [IMpower150]) and analyzed by tx (atezo-containing vs control) and irAE status. A time-dependent Cox model and landmark analyses at 1, 3, 6 and 12 mo were used to control for immortal bias. Study protocols required atezo tx interruption/discontinuation for grade (Gr) ≥3 irAEs. Results: 2503 pts were included in the analysis (atezo, n = 1577; control, n = 926). In both arms, baseline characteristics were generally balanced between pts with irAEs (atezo, n = 753; control, n = 289) and without irAEs (atezo, n = 824; control, n = 637). Any-Gr irAEs occurred in 48% (atezo) and 32% (control) of pts; Gr 3-5 irAEs occurred in 11% (atezo) and 5% (control). The most common irAEs (atezo vs control) were rash (28% vs 18%), hepatitis (lab abnormalities; 15% vs 10%) and hypothyroidism (12% vs 4%). Median time to onset of first irAE was 1.7 (atezo) vs 1.4 mo (control). OS HRs (95% CI) from the time-dependent Cox model between pts with vs without irAEs were 0.69 (0.60, 0.78) in the atezo arm and 0.82 (0.68, 0.99) in the control arm; after excluding rash (perceived as the least specific irAE), OS HRs (95% CI) were 0.75 (0.65, 0.87) and 0.90 (0.71, 1.12), respectively. OS landmark data are in the Table. Conclusions: In this exploratory pooled analysis, pts with irAEs had longer OS vs pts without irAEs in the atezo-containing and control arms per the time-dependent Cox model and landmark analyses; this trend remained for the atezo arm after excluding rash. Landmark analyses suggest that in the atezo arm, pts with Gr 1/2 irAEs had the longest OS and pts with Gr ≥3 irAEs had the shortest OS, potentially due to tx interruption/discontinuation. Clinical trial information: NCT02367781; NCT02657434; NCT02366143

Landmark
Atezo
with irAE
Atezo
with Gr 1/2 irAE
Atezo
with Gr 3-5 irAE
Atezo
without irAE
Control
with irAE
Control
without irAE

n

mOS, mo
n

mOS, mo
n

mOS, mo
n

mOS, mo
n

mOS, mo
n

mOS, mo
1 mo
305

22.2
247

23.8
58

11.3
1210

18.9
116

19.3
764

14.3
3 mo
451

23.1
370

24.8
81

16.6
963

19.6
180

19.1
625

16.0
6 mo
532

25.6
431

26.6
101

21.5
736

22.4
197

21.8
498

19.3
12 mo
519

32.7
428

33.4
91

29.9
455

27.5
175

31.8
329

25.5

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Oral Abstract Session

Session Title

Lung Cancer—Non-Small Cell Metastatic

Track

Lung Cancer

Sub Track

Metastatic Non–Small Cell Lung Cancer

Clinical Trial Registration Number

NCT02367781; NCT02657434; NCT02366143

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr 9002)

DOI

10.1200/JCO.2021.39.15_suppl.9002

Abstract #

9002

Abstract Disclosures