World Lung 2021 – Tecentriq's reduced role in adjuvant lung cancer looks likely

Tecentriq’s approvability for the adjuvant treatment of PD-L1-negative NSCLC patients is a long shot, and the drug also looks unlikely to play a role in those with stage I disease. This reminder came at World Lung this week, courtesy of a further analysis of Roche’s Impower-010 study, first unveiled at Asco. The trial has a sequential analysis, enrolling stage IB-IIIA NSCLC patients, but analysing disease-free survival first in PD-L1 ≥1% expressing then all-comer stage II-IIIA patients, and then in all randomised subjects. While the first two analyses came back positive, this obscured the fact that in PD-L1 negatives the hazard ratio was 0.97, with wide confidence intervals. At World Lung a forest plot from Impower-010 showed stage I patients yielding a 1.01 hazard ratio – both subgroup analyses effectively signifying no DFS benefit. These are not insignificant subgroups: 12% and 45% of Impower-010’s enrolees were stage I and PD-L1 negative respectively. In adjuvant NSCLC Tecentriq thus looks likely to be limited to PD-L1-expressing stage II-IIIA patients. Roche also has an Impower-010 late-breaker at Esmo, but attention will turn to the imminent readout of Merck & Co’s similar Keynote-091 trial, testing Keytruda in stage IB-IIIA patients regardless of PD-L1 expression.

Source: Dr Nasser Altorki & World Lung.

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