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ESMO 2020: Is Neoadjuvant Atezolizumab Safe in Patients With Resectable NSCLC?

By: Julia Fiederlein
Posted: Thursday, October 1, 2020

Surgery after one infusion of the antineoplastic agent atezolizumab appears to be safe in patients with non–small cell lung cancer (NSCLC), according to Benjamin Besse, MD, PhD, of the Institut Gustave Roussy, Villejuif, France, and colleagues. The results of the phase II PRINCEPS trial were presented during the European Society for Medical Oncology (ESMO) Virtual Congress 2020 (Abstract 1215O).

“Neoadjuvant immune checkpoint inhibitors induce major pathologic response rates in 17% to 45% of NSCLCs,” the investigators commented. “The short delay between [the administration of atezolizumab] and surgery might explain the absence of major pathologic responses.”

A total of 30 patients with clinical stage IA to IIIA NSCLC were intravenously administered 1,200 mg of atezolizumab. Subsequently, between days 21 and 28, the patients underwent surgery. The investigators analyzed fresh tumor tissue within 4 hours of surgery.

According to the investigators, all patients underwent surgery; no procedures were delayed by more than 15 days. A total of 29 patients had R0 resection status, and 1 patient had R1 resection status. Surgical complications were reported in three patients: one grade 3 respiratory distress with grade 4 sepsis; one heart block atrioventricular; and one grade 1 paresthesia. No grade 5 toxicities were observed. After surgery, one patient experienced grade 1 parietal pain. No patients achieved a radiologic response or major pathologic response.

Based on the SP142 assay, 15 of 29 tumors were PD-L1 TC3 or IC3 after treatment with atezolizumab. Necrosis was observed in 56% of tumors. Isolated or combined features of immune activation (n = 19), tissue repair (n = 15) and tumor cell death (n = 9) were reported in 20 of 29 cases. Next-generation sequencing of 23 tumors resulted in 14 TP53 mutations, 7 KRAS mutations, 3 EGFR mutations, 1 wild-type, and 1 STK11 mutation.

Disclosure: For full disclosures of the study authors, visit oncologypro.esmo.org.



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