Multicenter phase 2 trial of first-line atezolizumab plus bevacizumab for metastatic nsqNSCLC with high tumor mutation burden

Combinations of antiangiogenic and anti-PD-(L)1 agents are a novel treatment option for lung cancer. The activity of these combinations for tumors with high tumor mutation burden (TMB) is not known. The multicenter phase 2 TELMA trial in Spain evaluated the combination of atezolizumab and bevacizumab as first-line treatment for metastatic nonsquamous non-small cell lung cancer with TMB 10 or more mutations per megabase, without alterations in EGFR, ALK, STK11, MDM2 or ROS1. Response was seen in 42% of patients and response or stable disease in 79%. The 12-month PFS rate was 51.3% (95% CI 34,2-66.0), which met the primary end point, and 12-month OS rate was 72.0% (54.1-83.9). Most adverse events were grade 1 or 2. The authors conclude that atezolizumab plus bevacizumab is a potential first-line treatment for high TMB metastatic nsqNSCLC.