Multicenter phase 2 study of neoadjuvant atezolizumab for resectable non-small cell lung cancer

The survival of patients with resectable non-small cell lung cancer (NSCLC) has not substantially improved since the establishment of adjuvant chemotherapy as standard treatment more than 20 years ago. The multicenter LCMC3 study evaluated neoadjuvant atezolizumab (anti-PD-L1) for untreated, resectable, stage IB-IIIB NSCLC. Patients received two doses of neoadjuvant atezolizumab monotherapy. The primary end point was MPR (≤10% viable malignant cells) in resected tumors without EGFR or ALK alterations. This MPR was 20% (95% CI 14-28), meeting the prespecified primary endpoint of MPR at least 15%. With a minimum duration of follow-up of 3 years, the 3-year survival rate was 80%. The most common adverse event during the neoadjuvant phase were fatigue (39% of patients) and procedural pain (29%) along with expected immune-related toxicities. In exploratory analyses, MPR was predicted by immune cells in peripheral blood and in the tumor microenvironment.