Carboplatin and nab-paclitaxel chemotherapy with or without atezolizumab as front-line management for treatment-naive metastatic nonsquamous non-small cell lung cancer with PD-L1 staining: a retrospective study

Purpose The aim of this retrospective review was to compare the efficacy and safety of the atezolizumab plus carboplatin and nab-paclitaxel regimen versus the carboplatin and nab-paclitaxel regimen as front-line management for treatment-naive, metastatic nonsquamous programmed death-ligand 1 (PD-L1)-positive non-small cell lung cancer (NSCLC) in a selected population. Methods Consecutive patients with untreated, metastatic nonsquamous PD-L1-positive NSCLC who initially received the atezolizumab plus carboplatin and nab-paclitaxel (ACN) regimen or carboplatin and nab-paclitaxel (CN) regimen were retrospectively identified in two medical institutions from 2017 to 2020. The co-primary end points were overall survival (OS) and progression-free survival (PFS); secondary end point was the rate of key adverse events (AEs). Results In sum, 171 patients were retrospectively analysed, 47 of whom were excluded according to the criteria used in this study, leaving 124 patients (ACN: n = 60, median age 64 years [range 46-75]; CN: n = 64, 63 years [47-72]). The median duration of follow-up was 27 months [range 1-37]. At the final follow-up, the median OS was 19.9 months (95% confidence interval [CI], 16.3-22.5) in the ACN group vs. 14.8 months (95% CI 12.5-17.2) in the CN group (hazard ratio [HR] 0.51, 95% CI 0.33-0.77; p = 0.001). A marked distinction in the median PFS was seen (8.5 months [95% CI 6.7-9.4] in the ACN group vs. in the CN group [5.1 months [95% CI 3.6-6.8; HR 0.60; 95% CI 0.38-0.95; p = 0.005]). The rates of the key AEs (neutropenia and anaemia) were greater in the ACN group than in the CN group (all p < 0.05), but these AEs were manageable. Conclusion Among selected populations of individuals with treatment-naive, metastatic nonsquamous PD-L1-positive NSCLC, atezolizumab combined with carboplatin and nab-paclitaxel chemotherapy might have encouraging anticancer activity, with a tolerable safety profile.

Automated summary

This retrospective review compared the efficacy and safety of atezolizumab plus carboplatin and nab-paclitaxel regimen versus carboplatin and nab-paclitaxel regimen for treatment-naive, metastatic nonsquamous PD-L1-positive NSCLC. The study found that ACN regimen had better overall survival and progression-free survival, but had more adverse events.