# Real-World Comparative Study of Atezolizumab-Based Chemotherapy Regimens in Advanced Non-Small Cell Lung Cancer

## TL;DR

This study compares two chemotherapy regimens with atezolizumab for advanced lung cancer, finding one more effective in specific patient groups while the other causes fewer side effects.

## Contribution

The study provides real-world evidence comparing two atezolizumab-based regimens for non-small cell lung cancer, identifying subgroup-specific efficacy and safety differences.

## Key findings

- ABCP regimen showed improved progression-free and overall survival in patients with brain or liver metastases and specific tumor profiles.
- ACnP regimen had fewer side effects like nerve damage and low white blood cell counts.
- Objective response rates were higher with ACnP compared to ABCP.

## Abstract

Selecting the most appropriate first-line treatment for patients with advanced non-small cell lung cancer remains difficult in daily clinical practice, despite the availability of several effective combination therapies. This study compared two atezolizumab-based treatment regimens: one that included carboplatin, nab-paclitaxel, and atezolizumab, and the other that combined carboplatin, paclitaxel, bevacizumab, and atezolizumab, using real-world data from six hospitals in Japan. The aim was to clarify which regimen provides better outcomes and tolerability for different patient groups. The results suggest that the regimen containing bevacizumab may offer improved survival in patients with brain or liver metastases and in those with specific tumor profiles, while the nab-paclitaxel regimen caused fewer side effects such as nerve damage and low white blood cell counts. These findings may help physicians select more personalized and effective treatments for patients with advanced lung cancer in clinical practice.

Background/objective: Carboplatin, pemetrexed, and pembrolizumab are established as a key first-line regimen for metastatic non-small cell lung cancer, although selecting the optimal therapy for each patient remains challenging in real-world clinical practice. This retrospective multicenter study compared the efficacy and safety of two atezolizumab-based combination regimens, ACnP (carboplatin, nab-paclitaxel, atezolizumab) and ABCP (carboplatin, paclitaxel, bevacizumab, atezolizumab), in patients with non-small cell lung cancer in real-world clinical practice. Methods: A total of 91 patients treated between May 2018 and December 2023 at six Japanese hospitals were analyzed: 40 received ACnP and 51 received ABCP. Patient characteristics, treatment outcomes, and adverse events were compared, with subgroup analyses adjusted by inverse probability of treatment weighting using propensity scores. Results: The objective response rates were 55.0% with ACnP and 45.1% with ABCP. Median progression-free survival was 5.5 months for ACnP and 6.9 months for ABCP, while median overall survival was 16.2 and 18.3 months, respectively. Subgroup analyses showed significantly improved progression-free survival with ABCP in patients with brain metastases, liver metastases, EGFR-positive tumors, PD-L1-positive tumors, and impaired renal function (CCr < 45 mL/min). ABCP also conferred overall survival benefits in patients with brain and liver metastases. However, ACnP was associated with a lower incidence of neutropenia, peripheral neuropathy, and skin rash. Conclusions: These findings suggest that ABCP may offer superior efficacy in specific non-small cell lung cancer subgroups, while ACnP remains a valuable option for patients requiring a more tolerable safety profile.