Atezolizumab: A Review in Extensive-Stage SCLC
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ADIS DRUG EVALUATION
Atezolizumab: A Review in Extensive‑Stage SCLC James E. Frampton1
© Springer Nature Switzerland AG 2020
Abstract Atezolizumab (Tecentriq®), a fully humanized, monoclonal anti-programmed cell death ligand-1 (PD-L1) antibody, is the first immune checkpoint inhibitor to be approved, in combination with carboplatin and etoposide, for the treatment of adult patients with extensive-stage small cell lung cancer (ES-SCLC). Approval was based on primary data from the multinational phase I/III IMpower133 trial in PD-L1-unselected patients with previously untreated ES-SCLC. In this trial, induction therapy with atezolizumab plus carboplatin and etoposide followed by maintenance therapy with atezolizumab alone significantly prolonged overall survival (OS) and progression-free survival (PFS) compared with carboplatin and etoposide alone. The addition of atezolizumab to chemotherapy was generally well tolerated, with no new safety signals being identified beyond those previously reported for the individual agents. The most common grade 3–4 treatment-related adverse events with this regimen were haematological; the most common immune-related adverse events included rash and hypothyroidism. Importantly, the addition of atezolizumab to chemotherapy improved survival outcomes without adversely impacting patientreported health-related quality of life (HRQOL). Thus, atezolizumab in combination with carboplatin plus etoposide has emerged as a valuable option for the first-line treatment of ES-SCLC and is being accepted as a standard of care in this setting.
Atezolizumab: clinical considerations in ES‑SCLC First immunotherapy approved for first-line use Significantly prolongs OS and PFS when added to carboplatin and etoposide Generally well tolerated; no adverse impact on HRQOL
Enhanced Material For this Adis Drug Evaluation can be found at https://doi.org/10.6084/m9.figshare.12864284. The manuscript was reviewed by: L. Bonanno, Medical Oncology 2, Istituto Oncologico Veneto IOV- IRCCS, Padova, Italy; A.B. Schulze, Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany, N. Tsoukalas, Oncology Department, 401 General Military Hospital, Athens, Greece. Electronic supplementary material The online version of thisarticle (https://doi.org/10.1007/s40265-020-01398-6) containssupplementary material, which is available to authorized users. * James E. Frampton [email protected] 1
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1 Introduction Small cell lung cancer (SCLC) is an aggressive neuroendocrine tumour, characterized by rapid growth and high metastatic potential, which accounts for approximately 15% of all newly diagnosed lung cancers [1, 2]. Early detection is challenging due to the lack of specific symptoms; consequently, the majority (60–70%) of patients present with extrathoracic spread [i.e. extensive-stage (ES) disease] at initial diagnosis and, historically, have had limited treatment options and a
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