Journal Article

First-line atezolizumab monotherapy vs. single-agent chemotherapy in patients with advanced or metastatic non-small cell lung cancer who are ineligible for platinum-based therapy: Analysis of the IPSOS Asian subpopulation

Le, Anh Tuan, Huang, Dingzhi, Lee, Siow Ming, Han, Baohui, Zhong, Hua, Gitlitz, Barbara, Hoglander, Elen, Peters, Solange, Schulz, Christian, Morris, Stefanie, Pham, Cam Phuong, Zhao, Jun, Yang, Nong, Wu, Gang, Cao, Lejie, Wang, Kai, Hu, Youyou, Lam, Verena, Graupner, Vilma

2025

Overview

Lung cancer remains a significant medical problem in Asia, and improved treatments are needed for patients diagnosed with non-small cell lung cancer (NSCLC), who are frail with poor performance status or substantial comorbidities. This study aimed to investigate the efficacy and safety of first-line atezolizumab vs. single-agent chemotherapy in the Asian subpopulation in IPSOS trail. This exploratory analysis of the Asian subpopulation from the phase 3, global, open-label, randomized controlled IPSOS trial evaluated the efficacy and safety of atezolizumab (1200 mg intravenously every 3 weeks) vs. single-agent chemotherapy (investigator's choice of vinorelbine or gemcitabine) as first-line treatment in patients with locally advanced or metastatic NSCLC, who were ineligible for platinum-based chemotherapy. The primary outcome was overall survival (OS); other outcomes were progression-free survival (PFS), objective response rate (ORR), duration of response (DOR), and safety. Seventy patients from China and Vietnam were included. Median OS was 15.8 months in the atezolizumab group vs. 12.5 months in the chemotherapy group; unstratified hazard ratio, 0.74 (95% confidence interval 0.41, 1.35). Median PFS was 8.1 months vs. 5.4 months, ORR was 27.9% vs. 7.4%, and median DOR was 18.7 months vs. 9.3 months, in the atezolizumab group vs. in the chemotherapy group, respectively. All-grade and grade 3-4 treatment-related adverse events (AEs) were less frequent with atezolizumab compared with chemotherapy. Two patients in the atezolizumab group had grade 5 AEs, namely pneumonia and acute left ventricular failure, with the latter considered treatment-related. Atezolizumab showed encouraging efficacy results and was well tolerated in an Asian subpopulation of patients with NSCLC who were deemed ineligible for standard platinum-based chemotherapy. The findings of this exploratory subpopulation analysis were consistent with those for the global IPSOS population. ClinicalTrials.gov, NCT03191786.