Dr. Subramanian on the IMpower131 Trial in Squamous NSCLC

Janakiraman Subramanian, MD, medical oncologist, director of Thoracic Oncology, Center for Precision Medicine, Saint Luke’s Cancer Institute, discusses the IMpower131 trial in advanced squamous non—small cell lung cancer (NSCLC).

In the IMpower131 trial, patients were randomized to receive the combination of carboplatin and paclitaxel plus atezolizumab (Tecentriq) versus carboplatin and paclitaxel plus placebo. This was a complex, 3-arm study, that allowed for 2 different versions of paclitaxel in addition to the placebo arm, says Subramanian. The primary endpoints of the study were overall survival (OS) and progression-free survival (PFS). The results showed a clear benefit in PFS. At the time of the interim analysis, there was no significant difference in OS observed between arms.

It remains to be seen what the subsequent analysis will show, says Subramanian. Notably, at the 1-year interval, survival was not significantly different between 2 arms. However, the 2-year survival seemed to show a separation between the curves. Therefore, there is a group of patients with advanced squamous NSCLC who benefit from chemotherapy and immunotherapy. Determining who these patients are, how to best select them, and deliver the appropriate treatment to them is the key challenge that we will be better addressed once the final results of the study read out, adds Subramanian. Whether this combination will become a standard of care alongside pembrolizumab (Keytruda) and chemotherapy will depend on the final OS data, he concludes.