Skip to main content
SpringerLink
Log in

Atezolizumab: A Review in Extensive-Stage SCLC

  • Adis Drug Evaluation
  • Published:
Drugs Aims and scope Submit manuscript

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 patient-reported 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Wang S, Zimmermann S, Parikh K, et al. Current diagnosis and management of small-cell lung cancer. Mayo Clin Proc. 2019;94(8):1599–622.

    Article  Google Scholar 

  2. Yang S, Zhang Z, Wang Q. Emerging therapies for small cell lung cancer. J Hematol Oncol. 2019;12(1):47.

    Article  Google Scholar 

  3. Wilky BA. Immune checkpoint inhibitors: the linchpins of modern immunotherapy. Immunol Rev. 2019;290:6–23.

    Article  CAS  Google Scholar 

  4. Koury J, Lucero M, Cato C, et al. Immunotherapies: exploiting the immune system for cancer treatment. J Immunol Res. 2018;2018:9585614.

    Article  Google Scholar 

  5. Tsiouprou I, Zaharias A, Spyratos D. The role of immunotherapy in extensive stage small-cell lung cancer: a review of the literature. Can Respir J. 2019;2019:6860432.

    Article  Google Scholar 

  6. Armstrong SA, Liu SV. Immune checkpoint inhibitors in small cell lung cancer: a partially realized potential. Adv Ther. 2019;36(8):1826–32.

    Article  CAS  Google Scholar 

  7. Akinleye A, Rasool Z. Immune checkpoint inhibitors of PD-L1 as cancer therapeutics. J Hematol Oncol. 2019;12:92.

    Article  Google Scholar 

  8. Patel SP, Kurzrock R. PD-L1 expression as a predictive biomarker in cancer immunotherapy. Mol Cancer Ther. 2015;14(4):847–56.

    Article  CAS  Google Scholar 

  9. Kim JM, Chen DS. Immune escape to PD-L1/PD-1 blockade: seven steps to success (or failure). Ann Oncol. 2016;27(8):1492–504.

    Article  CAS  Google Scholar 

  10. Schmid S, Früh M. Immune checkpoint inhibitors and small cell lung cancer: what’s new? J Thorac Dis. 2018;10(Suppl 13):S1503–8.

    Article  Google Scholar 

  11. Calles A, Aguado G, Sandoval C, et al. The role of immunotherapy in small cell lung cancer. Clin Transl Oncol. 2019;21:961–76.

    Article  CAS  Google Scholar 

  12. Genentech.Tecentriq (atezolizumab): US prescribing information. 2020. https://www.gene.com. Accessed 6 Jul 2020.

  13. European Medicines Agency. Tecentriq (atezolizumab): EU summary of product characteristics. 2019. https://www.ema.europa.eu. Accessed 6 Jul 2020.

  14. Blair HA. Atezolizumab: a review in previously treated advanced non-small cell lung cancer. Target Oncol. 2018;13(3):399–407.

    Article  Google Scholar 

  15. Dhillon S, Syed YY. Atezolizumab first-line combination therapy: a review in metastatic nonsquamous NSCLC. Target Oncol. 2019;14(6):759–68.

    Article  Google Scholar 

  16. Kang C, Syed YY. Atezolizumab (in combination with nab-paclitaxel): a review in advanced triple-negative breast cancer. Drugs. 2020;80(6):601–7.

    Article  CAS  Google Scholar 

  17. Gong J, Chehrazi-Raffle A, Reddi S, et al. Development of PD-1 and PD-L1 inhibitors as a form of cancer immunotherapy: a comprehensive review of registration trials and future considerations. J Immunother Cancer. 2018;6:8.

    Article  Google Scholar 

  18. Chugai Pharmaceutical Co., Ltd. Tecentriq IV infusion 840mg /Tecentriq IV infusion 1200mg: Japanese prescribing information. 2019. https://www.pmda.go.jp. Accessed 19 May 2020.

  19. Horn L, Mansfield AS, Szczesna A, et al. First-line atezolizumab plus chemotherapy in extensive-stage small-cell lung cancer. N Engl J Med. 2018;379(23):2220–9.

    Article  CAS  Google Scholar 

  20. European Medicines Agency. Tecentriq: European public assessment report (EPAR). 2019. https://www.ema.europa.eu. Accessed 9 Apr 2020.

  21. Mansfield AS, Każarnowicz A, Karaseva N, et al. Safety and patient-reported outcomes of atezolizumab, carboplatin, and etoposide in extensive-stage small-cell lung cancer (IMpower133): a randomized phase I/III trial. Ann Oncol. 2020;31(2):310–7.

    Article  CAS  Google Scholar 

  22. Califano R, Kazarnowicz A, Karaseva N, et al. IMpower133: patient-reported outcomes (PROs) in a ph1/3 study of first-line (1L) atezolizumab (atezo) + carboplatin + etoposide (CP/ET) in extensive-stage SCLC (ES-SCLC) [abstract no. 316]. Ann Oncol. 2018;29(Suppl 10):x20.

    Google Scholar 

  23. Nishio M, Sugawara S, Atagi S, et al. Subgroup analysis of Japanese patients in a phase III study of atezolizumab in extensive-stage small-cell lung cancer (IMpower133). Clin Lung Cancer. 2019;20(6):469–76.e1.

    Article  CAS  Google Scholar 

  24. FDA approves durvalumab for extensive-stage small cell lung cancer [media release]. 30 Mar 2020. https://www.fda.gov/.

  25. Kim H, Chung J-H. PD-L1 testing in non-small cell lung cancer: past, present, and future. J Pathol Transl Med. 2019;53:199–206.

    Article  Google Scholar 

  26. Tian Y, Zhai X, Han A, et al. Potential immune escape mechanisms underlying the distinct clinical outcome of immune checkpoint blockades in small cell lung cancer. J Hematol Oncol. 2019;12:67.

    Article  Google Scholar 

  27. Chiang AC, Sequist LVD, Gilbert J, et al. Clinical activity and safety of atezolizumab in a phase 1 study of patients with relapsed/refractory small-cell lung cancer. Clin Lung Cancer. 2020;21(5):455–63.e4.

    Article  CAS  Google Scholar 

  28. Reguart N, Marin E, Remon J, et al. In search of the long-desired ‘Copernican Therapeutic Revolution’ in small-cell lung cancer. Drugs. 2020;89:241–62.

    Article  Google Scholar 

  29. Willis C, Fiander M, Tran D, et al. Tumour mutational burden in lung cancer: a systematic literature review. Oncotarget. 2019;10(61):6604–22.

    Article  Google Scholar 

  30. Ahmed Y, Calvert P, Dennehy C, et al. Immune checkpoint inhibitors in the driver’s seat: evaluating the evolving evidence in the treatment of extensive-stage small-cell lung cancer. J Curr Oncol. 2019;2:43–8.

    Article  Google Scholar 

  31. National Comprehensive Cancer Network. NCCN guidelines version 3. 2020. Small cell lung cancer. https://www.nccn.org. Accessed 13 May 2020.

  32. Rudin CM, Ismaila N, Hann CL, et al. Treatment of small-cell lung cancer: American Society of Clinical Oncology endorsement of the American College of Chest Physicians Guideline. J Clin Oncol. 2015;33(34):4106–11.

    Article  CAS  Google Scholar 

  33. Früh M, De Ruysscher D, Popat S, et al. Small-cell lung cancer (SCLC): ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(Suppl 6):vi99–105.

    Article  Google Scholar 

  34. McCune S, Ton T, Whipple S, et al. New treatment option for ES-SCLC: patient characteristics and use of an atezolizumab regimen in the real-world [abstract no. EP1.12-06]. J Thorac Oncol. 2019;14(10 Suppl):S1018–9.

    Article  Google Scholar 

  35. National Institute for Health and Care Excellence. Atezolizumab with carboplatin and etoposide for untreated extensive-stage small-cell lung cancer. Technology appraisal guidance [TA638]. https://www.nice.org.uk/guidance/ta638. Accessed 6 Jul 2020.

Download references

Acknowledgements

During the peer review process, the manufacturer of atezolizumab was also offered an opportunity to review this article. Changes resulting from comments received were made on the basis of scientific and editorial merit.

Author information

Authors and Affiliations

  1. Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand

    James E. Frampton

Authors
  1. James E. Frampton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to James E. Frampton.

Ethics declarations

Funding

The preparation of this review was not supported by any external funding.

Authorship and Conflict of interest

James E. Frampton is a salaried employee of Adis International Ltd/Springer Nature, and declares no relevant conflicts of interest. All authors contributed to the review and are responsible for the article content.

Ethics approval, Consent to participate, Consent to publish, Availability of data and material, Code availability

Not applicable.

Additional information

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

Below is the link to the electronic supplementary material.

Atezolizumab Animated Figure - External Review (MP4 24281 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Frampton, J.E. Atezolizumab: A Review in Extensive-Stage SCLC. Drugs 80, 1587–1594 (2020). https://doi.org/10.1007/s40265-020-01398-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40265-020-01398-6

Search

Navigation