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Gregory J. Riely, MD, PhD
Gregory J. Riely, MD, PhD
Posted: Thursday, March 16, 2023
Researchers sought to assess the clinical benefits and safety of treatment with atezolizumab plus bevacizumab for patients with high tumor mutation burden (TMB), advanced, nonsquamous non–small cell lung cancer (NSCLC). Mariano Provencio, MD, PhD, of Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, and colleagues discovered a favorable safety profile and clinical activity for this treatment combination, suggesting the possibility of its becoming a standard treatment for this patient population.
“The superiority—or noninferiority—of the combination compared with PD-1 and PD-L1 inhibitor monotherapy or in combination with chemotherapy in patients with high TMB warrants further study,” stated the investigators in an article in JAMA Oncology.
The researchers focused on 38 treatment-naive patients with confirmed stage IIIB to IV nonsquamous NSCLC with a TMB of 10 or more mutations/megabase and no EGFR, ALK, STK11, MDM2, or ROS1 alterations. The patients were assessed between May 2019 and January 2021 at various locations in Spain. Each patient was given atezolizumab at 1,200 mg plus bevacizumab at 15 mg/kg every 21 days. This treatment was continued until disease progression, unacceptable toxicity, patient withdrawal, investigator decision, or death.
After 12 months, the overall survival rate was 72.0%, and the progression-free survival rate was 51.3%. The median progression-free survival was 13 months, and the median overall survival was not reached. Of the 38 patients, 16 (42.1%) achieved an objective response, and 30 (78.9%) achieved disease control. The median time to response was 2.8 months, and the median duration of response was 11.7 months.
According to the investigators, most adverse events were grade 1 or 2. The most frequently reported side effects were fatigue and pruritus with atezolizumab and hypertension and proteinuria with bevacizumab.
The researchers acknowledged that their study had limitations, including the single-arm design and limited patient cohort size. They also noted that more research is needed to confirm the safety and efficacy of the proposed treatment combination.
Disclosure: For the full disclosures of the study authors, visit jamanetwork.com.
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