Multicenter retrospective study of chemo-immunotherapy versus chemotherapy after EGFR-TKI for EGFR-mutated NSCLC

The retrospective SPIRAL-STEP study, at 20 centers in Japan, included EGFR-mutated NSCLC patients after EGFR-TKI. Among 408 patients, 75% received platinum-based chemotherapy with or without bevacizumab (chemo group) and 25% received chemo-immunotherapy with atezolizumab, bevacizumab, carboplatin, and paclitaxel (ABCP group). After propensity score matching, no significant differences were noted between chemo and ABCP in progression-free survival (median 6.0 versus 7.2 months; p=0.44) or overall survival (median 22.5 versus 21.3 months; p=0.84). Analysis of the subset of patient with PD-L1 expression ≥ 50% showed significant better PFS with ABCP versus chemo (7.9 versus 4.8 months; p=0.02). The authors conclude that in patients with EGFR-mutant NSCLC previously treated with EGFR-TKI, ABCP achieved comparable outcomes to platinum-based chemotherapy, whereas among patients with high PD-L1 expression, ABCP may be a superior treatment option.