TECENTRIQ - atezolizumab

Key points

Favourable opinion for reimbursement in combination with bevacizumab, paclitaxel and carboplatin, only in the first-line treatment of adult patients with metastatic non-squamous non-small cell lung cancer (NSCLC) without EGFR mutant or ALK-positive tumours.

What therapeutic improvement ?

Therapeutic improvement compared to the bevacizumab, paclitaxel and carboplatin combination.

Role in the care pathway ?

In the absence of an activating EGFR or BRAF mutation and ALK or ROS gene rearrangement, the standard first-line treatment in patients with no major comorbidities and with an ECOG performance status of 0 to 2 is based on chemotherapy combining a platinum-based drug with one of the following drugs: paclitaxel, docetaxel, gemcitabine, vinorelbine or pemetrexed, depending on the patient’s age (< or ≥ 70 years). The combination of bevacizumab with dual platinum-based chemotherapy is a first-line treatment option in certain patients, in the absence of contraindications and in the event of an ECOG performance status of 0 or 1.

Recently, immunotherapy has changed these standards. Hence pembrolizumab is a first-line treatment in metastatic non-squamous NSCLC :

• as monotherapy in patients whose tumours strongly express PD-L1 ligand with a tumour proportion score [TPS] ≥ 50% and not presenting a tumour EGFR mutation or ALK rearrangement,
• in combination with pemetrexed + platinum salt chemotherapy in patients with an ECOG status of 0 or 1, irrespective of PD-L1 expression rate, and whose tumours do not present EGFR or ALK mutations.

Role of the medicinal product in the care pathway

TECENTRIQ (atezolizumab) in combination with bevacizumab, paclitaxel and carboplatin, remains a first-line alternative for the treatment of patients with metastatic non-squamous NSCLC without EGFR mutant or ALK-positive tumours.

In the absence of a demonstrative analysis on the basis of expression of PD-L1 tumour proportion score [TPS], the efficacy of TECENTRIQ (atezolizumab) in combination with bevacizumab, paclitaxel and carboplatin according to PD-L1 status is not known. Furthermore, the Commission reiterates that the role of TECENTRIQ (atezolizumab) in combination with bevacizumab, carboplatin and paclitaxel compared to pembrolizumab (as monotherapy in patients with PD-L1 expression ≥ 50% or in combination with chemotherapy irrespective of PD-L1 expression status) is not known, in the absence of comparative data.

The choice of treatment between immunotherapy alone and immunochemotherapy must take into account validated data in terms of the efficacy and safety (benefit/risk) of each of the options.

The Committee issues a warning about the risk of vascular complications associated with the use of bevacizumab in certain patients (see product SPC) and reiterates the fact that bevacizumab can only be considered in the absence of contraindications (see Transparency Committee opinion of 25/05/2016 relative to AVASTIN).

As a reminder, in patients whose tumours have an EGFR mutation or ALK rearrangement, TECENTRIQ (atezolizumab) in combination with bevacizumab and chemotherapy has no role in the care pathway due to a lack of available clinical data (see opinion of 9 October 2019).