Clinical activity and molecular correlates of response to atezolizumab alone or in combination with bevacizumab versus sunitinib in renal cell carcinoma
David F McDermott, Mahrukh A Huseni, Michael B Atkins, Robert J Motzer, Brian I Rini, Bernard Escudier, Lawrence Fong, Richard W Joseph, Sumanta K Pal, James A Reeves, Mario Sznol, John Hainsworth, W Kimryn Rathmell, Walter M Stadler, Thomas Hutson, Martin E Gore, Alain Ravaud, Sergio Bracarda, Cristina Suárez, Riccardo Danielli, Viktor Gruenwald, Toni K Choueiri, Dorothee Nickles, Suchit Jhunjhunwala, Elisabeth Piault-Louis, Alpa Thobhani, Jiaheng Qiu, Daniel S Chen, Priti S Hegde, Christina Schiff, Gregg D Fine, Thomas Powles, David F McDermott, Mahrukh A Huseni, Michael B Atkins, Robert J Motzer, Brian I Rini, Bernard Escudier, Lawrence Fong, Richard W Joseph, Sumanta K Pal, James A Reeves, Mario Sznol, John Hainsworth, W Kimryn Rathmell, Walter M Stadler, Thomas Hutson, Martin E Gore, Alain Ravaud, Sergio Bracarda, Cristina Suárez, Riccardo Danielli, Viktor Gruenwald, Toni K Choueiri, Dorothee Nickles, Suchit Jhunjhunwala, Elisabeth Piault-Louis, Alpa Thobhani, Jiaheng Qiu, Daniel S Chen, Priti S Hegde, Christina Schiff, Gregg D Fine, Thomas Powles
Abstract
We describe results from IMmotion150, a randomized phase 2 study of atezolizumab (anti-PD-L1) alone or combined with bevacizumab (anti-VEGF) versus sunitinib in 305 patients with treatment-naive metastatic renal cell carcinoma. Co-primary endpoints were progression-free survival (PFS) in intent-to-treat and PD-L1+ populations. Intent-to-treat PFS hazard ratios for atezolizumab + bevacizumab or atezolizumab monotherapy versus sunitinib were 1.0 (95% confidence interval (CI), 0.69-1.45) and 1.19 (95% CI, 0.82-1.71), respectively; PD-L1+ PFS hazard ratios were 0.64 (95% CI, 0.38-1.08) and 1.03 (95% CI, 0.63-1.67), respectively. Exploratory biomarker analyses indicated that tumor mutation and neoantigen burden were not associated with PFS. Angiogenesis, T-effector/IFN-γ response, and myeloid inflammatory gene expression signatures were strongly and differentially associated with PFS within and across the treatments. These molecular profiles suggest that prediction of outcomes with anti-VEGF and immunotherapy may be possible and offer mechanistic insights into how blocking VEGF may overcome resistance to immune checkpoint blockade.
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Source: PubMed