New targeted therapy for lung cancer broadens options for second-line therapy
Atezolizumab a programmed death-ligand 1 (PD-L1) inhibitor, is now approved for the treatment of patients with metastatic non-small cell lung cancer (NSCLC) and have disease progression during or following a platinum-based therapy.
Patients with EGFR or ALK genomic tumour aberrations will need to have disease progression on approved therapy for these aberrations prior to receiving atezolizumab.
Atezolizumab (Tecentriq®) has been included in Roche’s Patient Assistance Program, which subsidizes certain medications from Roche to support patients in handling their overall treatment cost.
In the multicenter OAK*study, which recruited patients who had squamous or non-squamous non-small-cell lung cancer and randomized them to receive either atezolizumab or docetaxel in patients who were previously treated with one to two cytotoxic (platinum-based combination) chemotherapy regimens, it was demonstrated that overall survival was significantly improved with atezolizumab compared with docetaxel. Patients in the atezolizumab arm lived for a median of 13.8 months, which is 4.2 months longer than those in the docetaxel group. This was seen in both the Intention-To-Treat (ITT) and the PD-L1 expression populations. [Lancet 2017;389(10066);255–265]
The OAK study also demonstrated atezolizumab to be safe with fewer adverse events compared with docetaxel. Fifteen percent of patients on atezolizumab reported grade 3 or 4 adverse events while 43 percent of patients on docetaxel reported grade 3 or 4 adverse events. [Primary analysis from OAK, presented at The European Society for Medical Oncology Meeting 2016] Atezolizumab’s efficacy also extends to all types of NSCLC patients regardless of their PD-L1 status (positive or negative), as well as both squamous and non-squamous categories.
Locally, some patients will also be recruited into a multicentre clinical study called TAIL**. The study will collect data on the safety and efficacy of atezolizumab. “I am pleased to share that from 20 patients, we had extended the patient enrollment to 30, and the study enrollment will end by September 2018, which is ahead of the planned December 2018 timeline. As of today (end July), we had enrolled 25 patients within 5.5 months,” said Lance Duan, managing director, Roche (Malaysia) Sdn Bhd.
Atezolizumab safe, easy to dose
PD-L1 is a transmembrane protein found on dendritic cells. The protein interacts with the programmed cell death-1 (PD-1) protein found on the surface of activated T cells to suppress T cell activity. The interaction between PD-1 and PD-L1 enables the immune system to be activated only when required and reduces the possibility of a chronic autoimmune condition.
In some cancers, the tumour cells have PD-L1 protein on their surface, which inhibits T cells from attacking and destroying them. Atezolizumab’s function is to inhibit PD-L1 activity, thus allowing T cells to reactivate and carry out their tumour killing function.
Lung cancer is the leading cause of cancer-related deaths worldwide. Out of 1.8 million people diagnosed with lung cancer in 2012, 1.6 million died. Locally, lung cancer is the second most common cause of death due to cancer with a total of 4,088 deaths annually. [Med J Malaysia 2016;71(Suppl 1):70–78] Due to its lack of symptoms, diagnosis is usually late.
Dato’ Dr Mohamed Ibrahim Abdul Wahid, a consultant clinical oncologist, said: “In Malaysia, 75 to 88 percent of cases are diagnosed in Stages 3 and 4, by which treatment is mostly restricted to tumour control and palliative care. The emergence of immunotherapy presents a viable treatment due to its fewer side effects and high tolerability profiles.”
*OAK: Atezolizumab versus docetaxel in patients with previously treated non-small-cell lung cancer
**TAIL: A Study of Atezolizumab (Tecentriq) to Investigate Long-term Safety and Efficacy in Previously-treated Participants with Locally Advanced or Metastatic Non-small Cell Lung Cancer