Carboplatin and nab-paclitaxel chemotherapy with or without atezolizumab as front-line management for treatment-naïve metastatic nonsquamous non-small cell lung cancer with PD-L1 staining: a retrospective study

PURPOSE: The aim of this retrospective review was to compare the efficacy and safety of the atezolizumab plus carboplatin and nab-paclitaxel regimen versus the carboplatin and nab-paclitaxel regimen as front-line management for treatment-naïve, metastatic nonsquamous programmed death-ligand 1 (PD-L1)-positive non-small cell lung cancer (NSCLC) in a selected population. METHODS: Consecutive patients with untreated, metastatic nonsquamous PD-L1-positive NSCLC who initially received the atezolizumab plus carboplatin and nab-paclitaxel (ACN) regimen or carboplatin and nab-paclitaxel (CN) regimen were retrospectively identified in two medical institutions from 2017 to 2020. The co-primary end points were overall survival (OS) and progression-free survival (PFS); secondary end point was the rate of key adverse events (AEs). RESULTS: In sum, 171 patients were retrospectively analysed, 47 of whom were excluded according to the criteria used in this study, leaving 124 patients (ACN: n = 60, median age 64 years [range 46–75]; CN: n = 64, 63 years [47–72]). The median duration of follow-up was 27 months [range 1–37]. At the final follow-up, the median OS was 19.9 months (95% confidence interval [CI], 16.3–22.5) in the ACN group vs. 14.8 months (95% CI 12.5–17.2) in the CN group (hazard ratio [HR] 0.51, 95% CI 0.33–0.77; p = 0.001). A marked distinction in the median PFS was seen (8.5 months [95% CI 6.7–9.4] in the ACN group vs. in the CN group [5.1 months [95% CI 3.6–6.8; HR 0.60; 95% CI 0.38–0.95; p = 0.005]). The rates of the key AEs (neutropenia and anaemia) were greater in the ACN group than in the CN group (all p < 0.05), but these AEs were manageable. CONCLUSION: Among selected populations of individuals with treatment-naïve, metastatic nonsquamous PD-L1-positive NSCLC, atezolizumab combined with carboplatin and nab-paclitaxel chemotherapy might have encouraging anticancer activity, with a tolerable safety profile.