Eric Nadler, MD, MDD

In an interview with Targeted Oncology™, Eric S. Nadler, MD, the medical director of US Oncology Health Informatics and Internet Technology and an oncologist at Texas Oncology, discusses the real-world patient characteristics and treatment duration of the immunotherapy combination treatment of the IMpower133 trial (NCT02763579) in patients with extensive-stage small cell lung cancer (ES-SCLC).

The randomized, phase I/III, multicenter, double-blinded, placebo-controlled IMpower133 trial examined a total of 408 patients with ES-SCLC between October 1, 2018, and December 31, 2019. Patients were then followed up through March 31, 2020, in order to evaluate the safety and efficacy of atezolizumab (Tecentriq) in combination with carboplatin plus etoposide (CE) vs placebo plus CE in chemotherapy-naive patients.

Findings showed the real-word treatment duration data to be similar to results of the IMpower133 study and the real-world implications that immunotherapy has had on the ES-SCLC space. While the results were not a surprise, according to Nadler, they have helped establish the usefulness of immunotherapy in this patient population.

 I don't think there is anything shocking or surprising. It showed 2 things at the end of the day. It showed that it was readily adopted almost immediately, the majority of patients were getting chemoimmunotherapy immediately from the publication and presentation of this data and its adoption. Some people think that it takes 18 months, sometimes even longer than that to funnel innovation to community physicians, but this actually shows that almost immediately, or at least the comfort of using immunotherapy in other diseases and in lung cancer must have been in embedded in the network, because as soon as it was FDA approved, it was adopted almost entirely throughout the network in a very short period of time.

Then the second thing is, I would imagine that the data that was presented would echo real world findings. I didn't think that patients being a little bit old or those who had brain metastases, or a little worse projected survival would not be able to tolerate the addition of immunotherapy to it. The fact that it echoed the data we saw in [Impower133] was not actually a surprising finding. I would have expected that. It was just nice that both of those things bore out.

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Eric S. Nadler, MD of Texas Oncology, discusses the real-world patient characteristics and treatment duration of the immunotherapy combination treatment of the IMpower133 trial in patients with extensive-stage small cell lung cancer.

Real-World Implications of the IMpower133 Trial in ES-SCLC

Eric Nadler, MD, MPP, the medical director of Health Informatics and Internet Technology for The US Oncology Network and an oncologist at Texas Oncology, discusses the design and goals of a retrospective study of real-world adoption of atezolizumab (Tecentriq) immunotherapy in extensive-stage small cell lung cancer (ES-SCLC).

The IMpower133 trial (NCT02763579) showed efficacy of the combination of atezolizumab, carboplatin, and etoposide in patients with ES-SCLC. Nadler and other investigators researched how community oncologists adopted chemoimmunotherapy based onthe iKnowMed electronic health record data.

Nadler says the goals of this study were to see how quickly the regimen was adopted and how much efficacy it had a real-world population that included patients who would not have been accepted into the clinical study due to age or poor health.

According to Nadler, they collected data about patients with ES-SCLC from October 2018 through December 31, 2019 to see how physicians adopted the regimen following its first presentation, and identified 267 patients who received chemoimmunotherapy with atezolizumab, while finding that only 23% as many patients received chemotherapy alone.

The retrospective study found that oncologists adopted the regimen fairly quickly after the clinical data were published, and that was tolerable in the real-world population that included patients with comorbidities.

 Basically, we wanted to study 2 things. We wanted to look at the adoption pattern of immunotherapy in the community after the publication and presentation of IMpower133. So, we wanted to see how quickly it would take doctors in a large community network, the largest community network, to actually begin to bring in immunotherapy into their practice.

And, secondarily, to be honest, we wanted to look at the efficacy of it, and see if you extend it to real world patients which tend to be sicker and older and have a lot more comorbidities. They don't have the same stringency of entry criterion when you offer that type of therapy in clinical trials. It’s very stringent which types of patients you're allowed to offer therapy to. But in the community, you can offer it to anybody you think is appropriate. So, that was a background of why we did it.

We did it—the dates of the study were between October 2018 through December 31, 2019. So, basically, the moment [Impower133] was presented, even before it's FDA approved, for about an 18 month follow up. We looked at just under 350 patients who received that regimen. And once we audited the data, 267 were found to actually have chemo immunotherapy with [atezolizumab]. And we did have a competitor arm, just to kind of look at and engage it, and it was a quarter of the percentage; 23% had [chemotherapy] alone.

Eric Nadler, MD, MPP, discusses the design and goals of a retrospective study of real-world adoption of atezolizumab immunotherapy in extensive-stage small cell lung cancer.

Eric Nadler, MD, MDD | Authors

Articles

Real-World Implications of the IMpower133 Trial in ES-SCLC

Retrospective Study Shows Adoption of Immunotherapy in ES-SCLC