Reference Detail

Ref Type

Journal Article

PMID

(27939400)

Authors

Balar AV, Galsky MD, Rosenberg JE, Powles T, Petrylak DP, Bellmunt J, Loriot Y, Necchi A, Hoffman-Censits J, Perez-Gracia JL, Dawson NA, van der Heijden MS, Dreicer R, Srinivas S, Retz MM, Joseph RW, Drakaki A, Vaishampayan UN, Sridhar SS, Quinn DI, Durán I, Shaffer DR, Eigl BJ, Grivas PD, Yu EY, Li S, Kadel EE, Boyd Z, Bourgon R, Hegde PS, Mariathasan S, Thåström A, Abidoye OO, Fine GD, Bajorin DF, IMvigor210 Study Group

Title

Atezolizumab as first-line treatment in cisplatin-ineligible patients with locally advanced and metastatic urothelial carcinoma: a single-arm, multicentre, phase 2 trial.

Journal	Vol	Issue	Date	Pages	Journal Short Title
Lancet (London, England)	389	10064	2017 01 07	67-76	Lancet

URL

Abstract Text

First-line chemotherapy for patients with cisplatin-ineligible locally advanced or metastatic urothelial carcinoma is associated with short response duration, poor survival, and high toxicity. This study assessed atezolizumab (anti-programmed death-ligand 1 [PD-L1]) as treatment for metastatic urothelial cancer in cisplatin-ineligible patients.For this single-arm, multicentre, phase 2 study, in 47 academic medical centres and community oncology practices in seven countries in North America and Europe, we recruited previously untreated patients with locally advanced or metastatic urothelial cancer who were cisplatin ineligible. Patients were given 1200 mg intravenous atezolizumab every 21 days until progression. The primary endpoint was independently confirmed objective response rate per Response Evaluation Criteria in Solid Tumors version 1.1 (central review), assessed in prespecified subgroups based on PD-L1 expression and in all patients. All participants who received one or more doses of atezolizumab were included in the primary and safety analyses. This study was registered with ClinicalTrials.gov, number NCT02108652.Between June 9, 2014, and March 30, 2015, we enrolled 123 patients, of whom 119 received one or more doses of atezolizumab. At 17·2 months' median follow-up, the objective response rate was 23% (95% CI 16 to 31), the complete response rate was 9% (n=11), and 19 of 27 responses were ongoing. Median response duration was not reached. Responses occurred across all PD-L1 and poor prognostic factor subgroups. Median progression-free survival was 2·7 months (2·1 to 4·2). Median overall survival was 15·9 months (10·4 to not estimable). Tumour mutation load was associated with response. Treatment-related adverse events that occurred in 10% or more of patients were fatigue (36 [30%] patients), diarrhoea (14 [12%] patients), and pruritus (13 [11%] patients). One treatment-related death (sepsis) occurred. Nine (8%) patients had an adverse event leading to treatment discontinuation. Immune-mediated events occurred in 14 (12%) patients.Atezolizumab showed encouraging durable response rates, survival, and tolerability, supporting its therapeutic use in untreated metastatic urothelial cancer.F Hoffmann-La Roche, Genentech.

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Molecular Profile	Treatment Approach
CD274 positive	Atezolizumab

Gene Name	Source	Synonyms	Protein Domains	Gene Description	Gene Role

Therapy Name	Drugs	Efficacy Evidence	Clinical Trials

Drug Name	Trade Name	Synonyms	Drug Classes	Drug Description

Gene	Variant	Impact	Protein Effect	Variant Description	Associated with drug Resistance

Molecular Profile	Indication/Tumor Type	Response Type	Therapy Name	Approval Status	Evidence Type	Efficacy Evidence	References
CD274 positive	transitional cell carcinoma	sensitive	Atezolizumab	Phase II	Actionable	In a Phase II trial (IMvigor210), treatment with Tecentriq (atezolizumab) resulted in an objective response rate (ORR) of 23% (27/119) in cisplatin-ineligible patients with previously untreated, locally advanced or metastatic urothelial cancer, and ORR was 28% (9/32, 4 complete responses, 5 partial responses) in patients with immune cell CD274 (PD-L1) expression greater than or equal to 5% (PMID: 27939400; NCT02108652).	27939400
CD274 positive	bladder urothelial carcinoma	sensitive	Atezolizumab	Phase II	Actionable	In a Phase II trial (IMvigor210), treatment with Tecentriq (atezolizumab) resulted in an objective response rate (ORR) of 23% (27/119) in cisplatin-ineligible patients with previously untreated, locally advanced or metastatic urothelial cancer, and ORR was 28% (9/32, 4 complete responses, 5 partial responses) in patients with immune cell CD274 (PD-L1) expression greater than or equal to 5% (PMID: 27939400; NCT02108652).	27939400