Introduction

Atezolizumab (trade name: Tecentriq) has been approved in Germany since September 2017 for the treatment of advanced lung cancer. It is a treatment option for adult patients with non-small-cell lung cancer who have already had chemotherapy.

Lung cancer is caused by the growth of malignant cells in the airways (bronchi) and their branches (bronchioles). It is also referred to as a bronchogenic carcinoma. There are two main types of tumors:

  • Small-cell lung cancer, SCLC
  • Non-small-cell lung cancer, NSCLC

NSCLC is surgically removed, if possible. But sometimes the tumor has already become too large or the cancer has spread to other parts of the body (metastasis) through the blood or lymphatic system. It is then called advanced lung cancer.

Atezolizumab blocks the effect of the PD-L1 protein produced by the tumor tissue. This protein prevents the immune system from attacking the tumor. Atezolizumab aims to block tumor growth by re-activating the immune system.

Application

Atezolizumab is given every three weeks at a dose of 1,200 mg as an infusion (IV drip) into a vein. Treatment is stopped if the disease progresses or if very severe side effects arise.

Other treatments

If previous chemotherapy has been unsuccessful, the standard treatments for people with advanced lung cancer are docetaxel, pemetrexed or nivolumab. If none of these standard treatments are possible, best supportive care (BSC) is used. BSC should be tailored to the patient's individual needs, relieve pain and other symptoms, and improve quality of life.

Assessment

In 2017, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) wanted to find out whether atezolizumab has any advantages or disadvantages for people with advanced lung cancer when compared with the current standard treatments.

In the studies provided by the manufacturer, only the data of patients who were able to have the standard treatments with docetaxel, pemetrexed or nivolumab were suitable for the analysis. 613 people had treatment with atezolizumab, another 612 received docetaxel. For these people, the following results were found:

What are the advantages of atezolizumab?

  • Life expectancy: Here the study suggests that atezolizumab has an advantage in people whose tumor has very high amounts of the protein PD-L1: Half of those who received atezolizumab had passed away within 20 to 21 months, while half of those who had the standard treatment had already passed away within only 10 months. For people with less PD-L1 on the tumor cells, no difference was found.
  • Loss of appetite: Here too, the study suggests that atezolizumab has an advantage for people with very high amounts of PD-L1. If they had treatment with atezolizumab, it took longer until they lost their appetite: Half of the people who used atezolizumab had lost their appetite after about 8 months, while half of those who had the standard treatment had already lost their appetite after about 3 months. No difference was observed in people with less PD-L1.
  • The study suggests that atezolizumab has an advantage in terms of these side effects, too:
    • Chest pain
    • Hair loss
    • Diarrhea
    • Coughing up blood
    • Sore mouth
    • Difficulty swallowing
    • Nerve inflammations
  • Compared to those who had the standard treatment, fewer people who received atezolizumab stopped their treatment due to side effects: In the atezolizumab group, about 8 out of 100 people stopped the treatment due to side effects, compared to about 18 out of 100 people who had the standard treatment.
  • There was also weak evidence that atezolizumab has advantages in terms of severe side effects such as
    • Pneumonia
    • Gastrointestinal (stomach and bowel) problems
    • Severe disorders of the blood and lymphatic system
    • Febrile neutropenia

What are the disadvantages of atezolizumab?

  • Immune-mediated severe side effects: Immune-mediated side effects are medical conditions in which a person's immune system attacks their own body. The study suggests that atezolizumab has a disadvantage here: Severe immune-mediated side effects occurred in 6 out of 100 people who used atezolizumab, compared to only 1 out of 100 people who had the standard treatment.
  • Severe conditions of the airways and chest: The study suggests that there is a disadvantage here too. About 11 out of 100 people who had treatment with atezolizumab had these severe side effects, compared to only 5 out of 100 people who had the standard treatment.
  • Serious skeletal muscle, connective tissue and bone diseases: The study suggests that atezolizumab had a disadvantage here, too. About 5 out of 100 people who received atezolizumab had these severe side effects, compared to only 2 out of 100 people who had the standard treatment.

No difference

  • Health-related quality of life: There was no difference between the treatments here.
  • No difference was found for the following symptoms either:
    • Nausea and vomiting
    • Breathing problems
    • Exhaustion
    • Sleep problems
    • Pain in the shoulders and arms
    • Constipation
    • Coughing

More information

This information summarizes the main results of a review produced by the Institute for Quality and Efficiency in Health Care (IQWiG, Germany). The review was commissioned by the German Federal Joint Committee (G-BA) as part of the “early benefit assessment of medications.” On the basis of the review and the hearings received, the G-BA passed a resolution on the added benefit of atezolizumab (Tecentriq).