Atezolizumab Monotherapy versus Chemotherapy in Untreated Locally Advanced or Metastatic Urothelial Carcinoma (IMvigor130): Final Overall Survival Analysis from a Randomised, Controlled, Phase 3 Study - Beyond the Abstract
Chemotherapy used in the control arm was both cis and carbo-platin based. Further analyses according to tumor PD-L1 expression and platinum derivative used showed that patients with high tumor PD-L1 expression would benefit from 1st-line atezolizumab compared to chemotherapy. When this subgroup analysis was limited to patients receiving carboplatin-based chemotherapy, this benefit was more pronounced. Therefore, the results of this study support the current EMA label of atezolizumab, i.e. cisplatin-ineligible patients with tumors highly expressing PD-L1.
This publication coincides with the recently reported results from the CheckMate 901 and EV-302/KEYNOTE-A39 trials, which will change the landscape in 1st-line treatment of mUC. ICIs are now positioned in the initial systemic treatment of this disease, which is in line with the design of the IMvigor130 study. The value of PD-L1 tumor expression as a predictive marker for immunotherapy (as suggested by the publication commented here) remains to be assessed in the context of the evolving standards.
Written by: Aristotelis Bamias MD, PhD, MRCP, Professor of Therapeutics-Internal Medicine-Oncology, National & Kapodistrian University of Athens
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