To no avel.
The Study: Immunotherapy is quickly grabbing turf for non-small cell lung cancer (NSCLC). But most of those wins have gone to the PD-1 inhibitors, nivolumab and pembrolizumab. The PD-L1 inhibitors have run a little behind, but atezolizumab recently made news with its improvements in overall survival both in the OAK trial (NSCLC) and IMpower133 trial (SCLC). In JAVELIN Lung 200, avelumab (an anti-PD-L1) faced up against docetaxel in platinum-refractory NSCLC. While patients weren’t required to have tumors expressing PD-L1, two-thirds in each arm did. This is where we start to feel bad for avelumab. When looking either overall or only in patients with PD-L1-expressing tumors, there was no improvement in survival outcomes. They had to dig deep to those with PD-L1 of >50% to uncover a benefit. To be fair, avelumab was less toxic and not numerically inferior. The problem is there are multiple immunotherapy agents with positive findings to fill almost any exploratory indication for avelumab in NSCLC. In fact, spell-checker just suggested we change “avelumab” to “nivolumab.” Ouch.
Bottom Line: The anti-PD-L1, avelumab, does not improve overall or progression-free survival in patients with platinum-refractory NSCLC. | Barlesi, Lancet Oncol 2018