Atezolizumab, bevacizumab, pemetrexed and platinum for EGFR-mutant NSCLC patients after EGFR TKI failure: A phase II study with immune cell profile analysis

Shang-Gin Wu , Chao-Chi Ho , James Chih-Hsin Yang , Shu-Han Yu , Yen-Feng Lin , Shu-Chin Lin , Bin-Chi Liao , Ching-Yao Yang , Yen-Ting Lin , Chong-Jen Yu , Ya-Ting Chuang , Wei-Yu Liao , Kah Yi Yap , Weng Si Kou , Jin-Yuan Shih

Clinical and Translational Medicine ›› 2025, Vol. 15 ›› Issue (1) : e70149

PDF
Clinical and Translational Medicine ›› 2025, Vol. 15 ›› Issue (1) : e70149 DOI: 10.1002/ctm2.70149
RESEARCH ARTICLE

Atezolizumab, bevacizumab, pemetrexed and platinum for EGFR-mutant NSCLC patients after EGFR TKI failure: A phase II study with immune cell profile analysis

Author information +
History +
PDF

Abstract

•The combination regimen yielded promising efficacy in NSCLC patients after EGFR-TKI resistance, particularly those with PD-L1-positive tumours.

•Higher peritumour NK cell and lower peripheral helper T cell were associated with favourable ORR and longer PFS, respectively.

•After disease progression, the proportion of S100A9+ MDSC increased, but Treg cells decreased.

Keywords

anti-angiogenesis / atezolizumab / EGFR TKI resistance / immune cell / tumour microenvironment

Cite this article

Download citation ▾
Shang-Gin Wu, Chao-Chi Ho, James Chih-Hsin Yang, Shu-Han Yu, Yen-Feng Lin, Shu-Chin Lin, Bin-Chi Liao, Ching-Yao Yang, Yen-Ting Lin, Chong-Jen Yu, Ya-Ting Chuang, Wei-Yu Liao, Kah Yi Yap, Weng Si Kou, Jin-Yuan Shih. Atezolizumab, bevacizumab, pemetrexed and platinum for EGFR-mutant NSCLC patients after EGFR TKI failure: A phase II study with immune cell profile analysis. Clinical and Translational Medicine, 2025, 15(1): e70149 DOI:10.1002/ctm2.70149

登录浏览全文

4963

注册一个新账户 忘记密码

References

[1]

Mok TS, Wu YL, Thongprasert S, et al. Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Engl J Med. 2009;361(10):947-957.

[2]

Maemondo M, Inoue A, Kobayashi K, et al. Gefitinib or chemotherapy for non-small-cell lung cancer with mutated EGFR. N Engl J Med. 2010;362(25):2380-2388.

[3]

Zhou C, Wu YL, Chen G, et al. Erlotinib versus chemotherapy as first-line treatment for patients with advanced EGFR mutation-positive non-small-cell lung cancer (OPTIMAL, CTONG-0802): a multicentre, open-label, randomised, phase 3 study. Lancet Oncol. 2011;12(8):735-742.

[4]

Sequist LV, Yang JC, Yamamoto N, et al. Phase III study of afatinib or cisplatin plus pemetrexed in patients with metastatic lung adenocarcinoma with EGFR mutations. J Clin Oncol. 2013;31(27):3327-3334.

[5]

Janne PA, Yang JC, Kim DW, et al. AZD9291 in EGFR inhibitor-resistant non-small-cell lung cancer. N Engl J Med. 2015;372(18):1689-1699.

[6]

Yu HA, Arcila ME, Rekhtman N, et al. Analysis of tumor specimens at the time of acquired resistance to EGFR-TKI therapy in 155 patients with EGFR-mutant lung cancers. Clin Cancer Res. 2013;19(8):2240-2247.

[7]

Yang CJ, Tsai MJ, Hung JY, et al. Pemetrexed had significantly better clinical efficacy in patients with stage IV lung adenocarcinoma with susceptible EGFR mutations receiving platinum-based chemotherapy after developing resistance to the first-line gefitinib treatment. Onco Targets Ther. 2016;9:1579-1587.

[8]

Tseng Y-H, Hung H-Y, Sung Y-C, et al. Efficacy of chemotherapy in epidermal growth factor receptor (EGFR) mutated metastatic pulmonary adenocarcinoma patients who had acquired resistance to first-line EGFR tyrosine kinase inhibitor (TKI). J Chemother. 2016;28(1):50-58.

[9]

Topalian SL, Hodi FS, Brahmer JR, et al. Safety, activity, and immune correlates of anti-PD-1 antibody in cancer. N Engl J Med. 2012;366(26):2443-2454.

[10]

Brahmer JR, Tykodi SS, Chow LQ, et al. Safety and activity of anti-PD-L1 antibody in patients with advanced cancer. N Engl J Med. 2012;366(26):2455-2465.

[11]

Herbst RS, Baas P, Kim DW, et al. Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small-cell lung cancer (KEYNOTE-010): a randomised controlled trial. Lancet. 2016;387(10027):1540-1550.

[12]

Socinski MA, Jotte RM, Cappuzzo F, et al. Atezolizumab for first-line treatment of metastatic nonsquamous NSCLC. N Engl J Med. 2018;378(24):2288-2301.

[13]

Offin M, Rizvi H, Tenet M, et al. Tumor mutation burden and efficacy of EGFR-tyrosine kinase inhibitors in patients with EGFR-mutant lung cancers. Clin Cancer Res. 2019;25(3):1063-1069.

[14]

Dong ZY, Zhang JT, Liu SY, et al. EGFR mutation correlates with uninflamed phenotype and weak immunogenicity, causing impaired response to PD-1 blockade in non-small cell lung cancer. Oncoimmunology. 2017;6(11):e1356145.

[15]

Isomoto K, Haratani K, Hayashi H, et al. Impact of EGFR-TKI treatment on the tumor immune microenvironment in EGFR mutation-positive non-small cell lung cancer. Clin Cancer Res. 2020;26(8):2037-2046.

[16]

Yang JC-H, Lee DH, Lee J-S, et al. Pemetrexed and platinum with or without pembrolizumab for tyrosine kinase inhibitor (TKI)-resistant, EGFR-mutant, metastatic nonsquamous NSCLC: phase 3 KEYNOTE-789 study. J Clin Oncol. 2023;41(17):LBA9000-LBA9000. suppl.

[17]

Mok TSK, Nakagawa K, Park K, et al. LBA8 Nivolumab (NIVO) + chemotherapy (chemo) vs chemo in patients (pts) with EGFR-mutated metastatic non-small cell lung cancer (mNSCLC) with disease progression after EGFR tyrosine kinase inhibitors (TKIs) in CheckMate 722. Ann Oncol. 2022;33:S1561-S1562.

[18]

Park S, Kim TM, Han JY, et al. A phase 3, randomized study of atezolizumab plus bevacizumab and chemotherapy in patients with EGFR or ALK mutated in non-small cell lung cancer (ATTLAS, KCSG-LU19-04). J Clin Oncol. 2023:101200jco2301891.

[19]

Shiraishi Y, Kishimoto J, Sugawara S, et al. Atezolizumab and platinum plus pemetrexed with or without bevacizumab for metastatic nonsquamous non-small cell lung cancer: a phase 3 randomized clinical trial. JAMA Oncol. 2024;10(3):315-324.

[20]

Fukumura D, Kloepper J, Amoozgar Z, et al. Enhancing cancer immunotherapy using antiangiogenics: opportunities and challenges. Nat Rev Clin Oncol. 2018;15(5):325-340.

[21]

Watanabe S, Furuya N, Nakamura A, et al. A phase II study of atezolizumab with bevacizumab, carboplatin, and paclitaxel for patients with EGFR-mutated NSCLC after TKI treatment failure (NEJ043 study). Eur J Cancer. 2024;197:113469.

[22]

Zhou C, Dong X, Chen G, et al. OA09.06 IMpower151: phase III study of atezolizumab + bevacizumab + chemotherapy in 1L metastatic nonsquamous NSCLC. J Thorac Oncol. 2023;18(11):S64-S65. Supplement.

[23]

Lu S, Wu L, Jian H, et al. Sintilimab plus chemotherapy for patients with EGFR-mutated non-squamous non-small-cell lung cancer with disease progression after EGFR tyrosine-kinase inhibitor therapy (ORIENT-31): second interim analysis from a double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Respir Med. 2023;11(7):624-636.

[24]

Lam TC, Tsang KC, Choi HC, et al. Combination atezolizumab, bevacizumab, pemetrexed and carboplatin for metastatic EGFR mutated NSCLC after TKI failure. Lung Cancer. 2021;159:18-26.

[25]

Midha A, Dearden S, McCormack R. EGFR mutation incidence in non-small-cell lung cancer of adenocarcinoma histology: a systematic review and global map by ethnicity (mutMapII). Am J Cancer Res. 2015;5(9):2892-2911.

[26]

Zhou M, Yu P, Qu X, et al. Phase III trials of standard chemotherapy with or without bevacizumab for ovarian cancer: a meta-analysis. PLoS One. 2013;8(12):e81858.

[27]

Lu S, Wu L, Jian H, et al. Sintilimab plus bevacizumab biosimilar IBI305 and chemotherapy for patients with EGFR-mutated non-squamous non-small-cell lung cancer who progressed on EGFR tyrosine-kinase inhibitor therapy (ORIENT-31): first interim results from a randomised, double-blind, multicentre, phase 3 trial. Lancet Oncol. 2022;23(9):1167-1179.

[28]

Ahn MJ, Tsai CM, Hsia TC, et al. Cost-effectiveness of bevacizumab-based therapy versus cisplatin plus pemetrexed for the first-line treatment of advanced non-squamous NSCLC in Korea and Taiwan. Asia Pac J Clin Oncol. 2011;7(2):22-33. Suppl.

[29]

Ferrara N, Hillan KJ, Gerber HP, et al. Discovery and development of bevacizumab, an anti-VEGF antibody for treating cancer. Nat Rev Drug Discov. 2004;3(5):391-400.

[30]

Motz GT, Santoro SP, Wang LP, et al. Tumor endothelium FasL establishes a selective immune barrier promoting tolerance in tumors. Nat Med. 2014;20(6):607-615.

[31]

Wallin JJ, Bendell JC, Funke R, et al. Atezolizumab in combination with bevacizumab enhances antigen-specific T-cell migration in metastatic renal cell carcinoma. Nat Commun. 2016;7:12624.

[32]

Roland CL, Lynn KD, Toombs JE, et al. Cytokine levels correlate with immune cell infiltration after anti-VEGF therapy in preclinical mouse models of breast cancer. PLoS One. 2009;4(11):e7669.

[33]

Facciabene A, Peng X, Hagemann IS, et al. Tumour hypoxia promotes tolerance and angiogenesis via CCL28 and T(reg) cells. Nature. 2011;475(7355):226-230.

[34]

Reck M, von Pawel J, Zatloukal P, et al. Phase III trial of cisplatin plus gemcitabine with either placebo or bevacizumab as first-line therapy for nonsquamous non-small-cell lung cancer: aVAil. J Clin Oncol. 2009;27(8):1227-1234.

[35]

Mok TS, Hsia TC, Tsai CM, et al. Efficacy of bevacizumab with cisplatin and gemcitabine in Asian patients with advanced or recurrent non-squamous non-small cell lung cancer who have not received prior chemotherapy: a substudy of the avastin in lung trial. Asia Pac J Clin Oncol. 2011;7(2):4-12. Suppl.

[36]

Zhou CH, Yang F, Jiang WJ, et al. Efficacy and safety of different doses of bevacizumab combined with pemetrexed and platinum in first-line treatment of advanced NSCLC: a retrospective-real world study. Front Pharmacol. 2021;12:727102.

[37]

Wu S-G, Chiang C-L, Wang C-C, et al. Clinical outcomes of atezolizumab therapy for previously-treated advanced-stage non-small cell lung cancer: a real-world study in Taiwan. J Cancer. 2022;13(9):2922-2932.

[38]

Seto T, Nosaki K, Shimokawa M, et al. Phase II study of atezolizumab with bevacizumab for non-squamous non-small cell lung cancer with high PD-L1 expression (@Be study). J Immunother Cancer. 2022;10(2):e004025.

[39]

Herbst RS, Giaccone G, de Marinis F, et al. Atezolizumab for first-line treatment of PD-L1-selected patients with NSCLC. N Engl J Med. 2020;383(14):1328-1339.

[40]

Investigators H-AS. Ivonescimab plus chemotherapy in non-small cell lung cancer with EGFR variant: a randomized clinical trial. JAMA. 2024;332(7):561-570.

[41]

Passaro A, Wang J, Wang Y, et al. Amivantamab plus chemotherapy with and without lazertinib in EGFR-mutant advanced NSCLC after disease progression on osimertinib: primary results from the phase III MARIPOSA-2 study. Ann Oncol. 2024;35(1):77-90.

[42]

Borghaei H, Paz-Ares L, Horn L, et al. Nivolumab versus docetaxel in advanced nonsquamous non-small-cell lung cancer. N Engl J Med. 2015;373(17):1627-1639.

[43]

Rittmeyer A, Barlesi F, Waterkamp D, et al. Atezolizumab versus docetaxel in patients with previously treated non-small-cell lung cancer (OAK): a phase 3, open-label, multicentre randomised controlled trial. Lancet. 2017;389(10066):255-265.

[44]

Spencer KR, Wang J, Silk AW, et al. Biomarkers for immunotherapy: current developments and challenges. Am Soc Clin Oncol Educ Book. 2016(36):e493-e503.

[45]

Sankar K, Ye JC, Li Z, et al. The role of biomarkers in personalized immunotherapy. Biomarker Res. 2022;10(1):32.

[46]

Gadgeel SM, Stevenson J, Langer CJ, et al. Pembrolizumab (pembro) plus chemotherapy as front-line therapy for advanced NSCLC: kEYNOTE-021 cohorts A-C. J Clin Oncol. 2016;34(15):9016-9016. suppl.

[47]

Davis AA, Patel VG. The role of PD-L1 expression as a predictive biomarker: an analysis of all US Food and Drug Administration (FDA) approvals of immune checkpoint inhibitors. J Immunother Cancer. 2019;7(1):278.

[48]

Zhang J, Dang F, Ren J, et al. Biochemical aspects of PD-L1 regulation in cancer immunotherapy. Trends Biochem Sci. 2018;43(12):1014-1032.

[49]

Zhou Y, Li L, Zhou D, et al. Natural killer cells contribute to ‘hot’ tumor regression in the allergic inflammatory environment. Int Immunopharmacol. 2023;123:110760.

[50]

Mandal R, Senbabaoglu Y, Desrichard A, et al. The head and neck cancer immune landscape and its immunotherapeutic implications. JCI Insight. 2016;1(17):e89829.

[51]

Souza-Fonseca-Guimaraes F, Cursons J, Huntington ND. The emergence of natural killer cells as a major target in cancer immunotherapy. Trends Immunol. 2019;40(2):142-158.

[52]

Hsu J, Hodgins JJ, Marathe M, et al. Contribution of NK cells to immunotherapy mediated by PD-1/PD-L1 blockade. J Clin Invest. 2018;128(10):4654-4668.

[53]

Herndler-Brandstetter D, Shan L, Yao Y, et al. Humanized mouse model supports development, function, and tissue residency of human natural killer cells. Proc Natl Acad Sci USA. 2017;114(45):E9626-E9634.

[54]

Lee H, Quek C, Silva I, et al. Integrated molecular and immunophenotypic analysis of NK cells in anti-PD-1 treated metastatic melanoma patients. Oncoimmunology. 2019;8(2):e1537581.

[55]

Bevan MJ. Helping the CD8(+) T-cell response. Nat Rev Immunol. 2004;4(8):595-602.

[56]

Borst J, Ahrends T, Babala N, et al. CD4(+) T cell help in cancer immunology and immunotherapy. Nat Rev Immunol. 2018;18(10):635-647.

[57]

Ahrends T, Busselaar J, Severson TM, et al. CD4(+) T cell help creates memory CD8(+) T cells with innate and help-independent recall capacities. Nat Commun. 2019;10(1):5531.

[58]

Janssen EM, Lemmens EE, Wolfe T, et al. CD4+ T cells are required for secondary expansion and memory in CD8+ T lymphocytes. Nature. 2003;421(6925):852-856.

[59]

Zuazo M, Arasanz H, Fernandez-Hinojal G, et al. Functional systemic CD4 immunity is required for clinical responses to PD-L1/PD-1 blockade therapy. EMBO Mol Med. 2019;11(7):e10293.

[60]

Kagamu H, Kitano S, Yamaguchi O, et al. CD4(+) T-cell immunity in the peripheral blood correlates with response to anti-PD-1 therapy. Cancer Immunol Res. 2020;8(3):334-344.

[61]

Inomata M, Kado T, Okazawa S, et al. Peripheral PD1-positive CD4 T-lymphocyte count can predict progression-free survival in patients with non-small cell lung cancer receiving immune checkpoint inhibitor. Anticancer Res. 2019;39(12):6887-6893.

[62]

Manjarrez-Orduno N, Menard LC, Kansal S, et al. Circulating T cell subpopulations correlate with immune responses at the tumor site and clinical response to PD1 inhibition in non-small cell lung cancer. Front Immunol. 2018;9:1613.

[63]

Möller M, Turzer S, Schütte W, et al. Blood immune cell biomarkers in patient with lung cancer undergoing treatment with checkpoint blockade. J Immunother. 2020;43(2):57-66.

[64]

Limagne E, Richard C, Thibaudin M, et al. Tim-3/galectin-9 pathway and mMDSC control primary and secondary resistances to PD-1 blockade in lung cancer patients. Oncoimmunology. 2019;8(4):e1564505.

[65]

Kang DH, Chung C, Sun P, et al. Circulating regulatory T cells predict efficacy and atypical responses in lung cancer patients treated with PD-1/PD-L1 inhibitors. Cancer Immunol Immunother. 2022;71(3):579-588.

[66]

Wu SG, Ho CC, Yang JC, et al. 12P A phase II study of atezolizumab in combination with bevacizumab, carboplatin or cisplatin, and pemetrexed for EGFR-mutant metastatic NSCLC patients after failure of EGFR TKIs. Ann Oncol. 2022;33:S33-S34.

[67]

Eberhardt WE, Mitchell A, Crowley J, et al. The IASLC lung cancer staging project: proposals for the revision of the M descriptors in the forthcoming eighth edition of the TNM classification of lung cancer. J Thorac Oncol. 2015;10(11):1515-1522.

[68]

Yu SH, Maynard JP, Vaghasia AM, et al. A role for paracrine interleukin-6 signaling in the tumor microenvironment in prostate tumor growth. Prostate. 2019;79(2):215-222.

[69]

Ye C-H, Peng G-R, Hu SY, et al. Establishment of multiplex IHC staining panel and immune subpopulation quantificationsystem for cancer prognosis. J Clin Oncol. 2022;40(16):e20525-e20525. suppl.

[70]

Simon R. Optimal two-stage designs for phase II clinical trials. Control Clin Trials. 1989;10(1):1-10.

RIGHTS & PERMISSIONS

2024 The Author(s). Clinical and Translational Medicine published by John Wiley & Sons Australia, Ltd on behalf of Shanghai Institute of Clinical Bioinformatics.

AI Summary AI Mindmap
PDF

117

Accesses

0

Citation

Detail

Sections
Recommended

AI思维导图

/