2022 ESMO Global Perspectives Prof. Siow Ming Lee: Immunologic monotherapy can also bring survival benefits to patients with poor NSCLC

The European Society for Internal Oncology (ESMO) Annual Meeting is the most prestigious and influential oncology conference
in Europe.

The 2022 ESMO Conference will be held from September 9 to 13, 2022 in an offline (Paris, France) combination of online methods, ESMO Conference covers basic research, translational research and the latest clinical research progress, will provide a broad and excellent academic platform
for clinical practice, multidisciplinary discussion, etc.

A number of blockbuster studies in the field of lung cancer will be presented at this year's ESMO conference
.

In the plenary session III, Professor Siow Ming Lee presented the results
of the Phase III IPSOS study.

During the conference, Professor Siow Ming Lee was honored to have Professor Siow Ming Lee interpret the findings
.

Details are as follows:

Professor Siow Ming Lee is in the view

Professor Siow Ming Lee

University College London Hospitals

Patients with poor advanced NSCLC urgently need better regimens

Virtually all first-line key immunotherapy studies included non-small cell lung cancer (NSCLC) patients with
a physical status (PS) score of 0 or 1 in the Eastern United States Collaborative Oncology Group (ECOG).

We know that the PS score status is not specified in the indications for immunomonotherapy PD-L1 expression > 50% of advanced NSCLC, but in fact, there are no prospective randomized controlled studies
in patients who are not suitable or unable to tolerate standard platinum-containing chemotherapy and PS scores of 2 or 3.

Therefore, we clinicians do not recommend immunotherapy plus chemotherapy for patients with advanced NSCLC who are in a poor state and have a PS of 2/3, because combination therapy is too
toxic for this part of the patient.

New advances or changes in clinical practice: Immunological monodrugs improve the survival of the elderly population and ensure a better quality of life

This year, our team presented the results of a Phase III IPSOS study at ESMO that showed that altilizumab monotherapy improves overall survival (OS)
in patients with poor NSCLC, predominantly older adults, regardless of physical status or PD-L1 expression.

The IPSOS study reached the primary endpoint of OS (HR=0.
78) and doubled the 2-year survival rate of patients (24.
3% vs 12.
4%), with a quarter of patients receiving antilizumab surviving at 2 years while maintaining a good quality of life, and no new adverse events
were found in this population.

Immunotherapy alone is effective
regardless of the patient's PD-L1 expression level.

The median age of patients included in the study was 75 years, 75% of patients over 70 years of age, and 31% of patients over 80 years of age, compared with the median age of enrollment in other first-line immunotherapy trials generally less than 65 years
.

IPSOS studies are likely to alter clinical practice in patients with poor PS scores or elderly patients with advanced NSCLC without driver gene mutations
.

Study details

Professor Siow Ming Lee

1

background

Multiple studies have shown that first-line immunotherapy ± chemotherapy significantly improves patient OS
compared with chemotherapy.

method

Patients with no driver gene mutation, poor PS (≥2), or complications over 70 years of age who are not suitable for locally advanced/metastatic NSCLC with platinum-containing double-agent chemotherapy were included in the study
.

Enrolled patients were randomly assigned to attilizumab (every 3 weeks, intravenously, 1200 mg) or monotherapy chemotherapy (vinorebine or gemcitabine) in a 2:1 ratio for 3 or 4 cycles
.

The main endpoint is OS
.

Key secondary endpoints were objective response rate (ORR), progression-free survival (PFS), and duration of response (DOR) and OS and PFS in PD-L1-positive populations
.
Study the design

3

outcome

A total of 453 patients were enrolled in the study and were randomly assigned to the attilizumab group (302 patients) and the chemotherapy group (151 patients
).

The median age was 75 years (range, 33-94), with 31% of patients over 80 years of age, 72% of men, and 83%
of patients with ECOG PS≥2.

The median follow-up time of 41.
0 months at data cut-off on 30 April 2022 significantly improved patient OS compared with chemotherapy (HR=0.
78; 95% CI: 0.
63, 0.
97; P=0.
028).


Primary endpoints: Consistent survival benefit was also observed in key subgroups with OS results
, including PD-L1 expression levels, PS and histology type subgroups
.

The OS subgroup analyzed
the ORR of 16.
9% and 7.
9%, respectively, and the median DOR of 14 months and 7.
8 months, respectively
, in the Atelizumab monotherapy group and the chemotherapy group, respectively.

The median PFS in
both groups was 4.
2 months and 4.
0 months (HR = 0.
87),
respectively.

The incidence of treatment-related adverse events (TRAE) in the secondary endpoints PFS
altilizumab group and the chemotherapy group was 16.
3% and 33.
3%, respectively, and the incidence of grade 5 TAE was 1.
0% and 2.
7%,
respectively.


Safety analysis compared with chemotherapy significantly improved the time to chest pain exacerbation time (TTCD) in patients with chest pain (HR=0.
51; 95% CI: 0.
27 to 0.
97), and found that there was also a significant improvement
in loss of appetite and cough compared with baseline.

Patients reported outcome TTCD outcomes

4

conclusion

Regardless of histology type, PD-L1 expression, and ECOG PS score, first-line altelizumab significantly improved OS unsuitable for platinum patients (HR=0.
78) compared with chemotherapy, and the estimated number of patients surviving at 2 years of attilizumab was twice that
of chemotherapy.

Antilizumab is associated with stable health-related quality of life and improved TTCD
in patients compared with chemotherapy.

Regardless of the subgroup population, the IPSOS study was the first prospective study to show improvements in OS in patients with poor prognosis, finding no new adverse events while ensuring quality of
life in patients 。 LBA11-IPSOS: Results from a phase III study of first-line (1L) atezolizumab (atezo) vs single-agent chemotherapy (chemo) in patients (pts) with NSCLC not eligible for a platinumcontaining regimen.
2022 ESMO.
Editor: Xiaoyuan Typesetting: Xiaoyuan Execution: Youshi