Efficacy of Atezolizumab, Bevacizumab, Carboplatin, and Paclitaxel Therapy in Patients With Genetic Alterations in Non-Small Cell Lung Cancer.

Background: The IMpower150 trial demonstrated the efficacy of atezolizumab, bevacizumab, carboplatin, and paclitaxel (ABCP) therapy in epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC). However, its efficacy in patients with NSCLC harboring other genetic alterations in real-world settings remains unclear. This study aimed to retrospectively evaluate the efficacy of ABCP therapy in patients with NSCLC harboring other genetic alterations.

Methods: We retrospectively analyzed 61 patients with advanced NSCLC (33 with EGFR mutations: EGFR group and 28 with other genetic alterations: other group) who received ABCP therapy between January 2019 and December 2023 at a single institution in Japan, and evaluated efficacy and toxicities.

Results: Most baseline characteristics were similar except treatment timing (p < 0.001) in both groups. The median progression-free survival (PFS) was 4.5 vs. 5.1 months (p = 0.663), and the objective response rate (ORR) was 45.5% vs. 50.0% (p = 0.77) between the EGFR and other groups. In multivariate analysis, PD-L1 expression ≥ 50% was independently associated with longer PFS (HR 0.23, p < 0.001). Grade ≥ 3 adverse events were manageable and occurred at similar rates (51.5% vs. 53.6%) between the EGFR and other groups, and discontinuation was low (9.8%). Subgroup analysis for patients with KRAS mutation (n = 14) and anaplastic lymphoma kinase (ALK) fusion (n = 6) showed trends consistent with the overall cohort.

Conclusions: ABCP therapy demonstrated efficacy and manageable toxicity in NSCLC patients in both groups. Notably, those with high PD-L1 expression (≥ 50%) may derive greater PFS benefit. Further confirmation in larger prospective trials is warranted.