Atezolizumab as a primer for chemoradiation is promising for women with locally advanced cervical cancer (79% vs. 59% disease free survival)

Medical Xpress / NRG Oncology / Society of Gynecologic Oncology (SGO) 2023 Annual Meeting ^ | March 27, 2023 | D. Zamarin et al

[ConservativeMind]

Locally advanced cervical cancer remains an area of high therapeutic need, with recent trials failing to demonstrate evidence of benefit from adjuvant chemotherapy or immune checkpoint blockade administered concurrent with chemoradiation. Results from the NRG-GY017 randomized trial comparing the anti-PD-L1 inhibitor atezolizumab before and concurrent with chemoradiation (CRT) indicated favorable outcomes for 2-year disease-free survival (DFS) and demonstrated evidence of improved immunogenicity with neoadjuvant atezolizumab in patients with locally advanced cervical cancer.

NRG-GY017 accrued 36 patients with pelvic or para-aortic lymph-node-positive, locally advanced cervical cancer and randomly assigned patients to receive either atezolizumab prior to and concurrently with CRT on treatment arm A or only atezolizumab concurrently with CRT on treatment arm B. Patients on Arm A received atezolizumab on days -21, 0, and 21 with CRT whereas patients on Arm B received atezolizumab on days 21 and 42 with CRT.

Median follow-up for this study was 25.8 months. The proportion of patients on Arm A with 2-year DFS was 79% versus 59% in Arm B (p=0.28). Patients in Arm A had a 69% pathologically complete or partial response compared to 40% in Arm B of the 31 patients with day 28 post-treatment biopsy data available.

There was no association found between the baseline PD-L1 status and 2-year DFS. Twenty-two patients had available baseline tumor and 80% in Arm A versus 75% in Arm B had positive PD-L1 immune infiltrate scoring (p=0.59). Arm A had 30% positive tumor cell PD-L1 scoring versus 83% in Arm B (p=0.02). Both were defined as straining at 1% or above.

[ConservativeMind]

Yet another good example of immunotherapy benefits when taken just three weeks earlier, for one day, prior to chemo and radiation.

It nets to a 34% improvement in survival over the “normal” approach.

[ConservativeMind]

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