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Research Investigates Role of Antiangiogenic Agents and Checkpoint Inhibitors in EGFR NSCLC

Heather A. Wakelee, MD
Published Online:8:33 PM, Mon August 12, 2019

Heather A. Wakelee, MD, professor of medicine at Stanford University, discusses recent research investigating antiangiogenic agents and checkpoint inhibitors in the frontline for patients with EGFR-positive non—small cell lung cancer (NSCLC). The most promising data were demonstrated in the phase III IMpower150 trial (NCT02366143).

Patients enrolled to the IMpower150 trial were treated with a 4-drug combination, including atezolizumab (Tecentriq), bevacizumab (Avastin), carboplatin, and paclitaxel. Patients with EGFR-positive NSCLC experienced an improvement in overall survival (OS) and progression-free survival (PFS) with the 4-drug regimen.

Other clinical trials investigated these agents in patients with advanced NSCLC, such as ECOG-ACRIN 5508 (NCT01107626)looking at maintenance bevacizumab alone versus in combination with pemetrexed or pemetrexed alone and the COMPASS trial (NCT01776424)investigating bevacizumab with or without pemetrexed after induction with carboplatin, pemetrexed, and bevacizumab. Both studies showed an improvement in PFS but not OS. However, these were exciting trial designs, Wakelee notes.

The IMpower150 trial was the first trial to combine antiangiogenic agents with immunotherapy; Wakelee says she is excited to see the checkpoint inhibitors being used in this space. PFS and OS were improved in all comers on the trial, including those with EGFRand ALKmutations. However, this is the only positive OS data seen in patients with driver mutations treated with immune checkpoint inhibitors.
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