Atezolizumab Plus Bevacizumab Might Help Some With Kidney Cancer

By David Douglas

May 29, 2019

NEW YORK (Reuters Health) - The anti-VEGF monoclonal antibody bevacizumab combined with the anti-PD-L1 antibody atezolizumab might beat sunitinib in some patients with previously untreated advanced renal-cell carcinoma (RCC), but uncertainty remains, according to a phase 3 trial.

"These data reinforce the clinical activity of combined immunotherapy and VEGF inhibitors in metastatic RCC," Dr. Brian I. Rini of the Cleveland Clinic, in Ohio, told Reuters Health by email. "This type of combination approach is well tolerated and should be considered a standard of care in RCC."

Dr. Rini and colleagues randomly assigned 915 patients to atezolizumab plus bevacizumab or to sunitinib; 40% of the patients had PD-L1-positive disease, they report in The Lancet, online May 9.

In the PD-L1-positive population, at a median of 15 months of follow-up, median progression-free survival was 11.2 months in the combination group and 7.7 months in the sunitinib patients (hazard ratio, 0.74; P=0.022).

At 24 months, the hazard ratio for overall survival was 0.93 in the intention-to-treat population, which "did not cross the significance boundary, and longer-term follow-up is necessary to establish whether a survival benefit will emerge."

In all, 40% of patients in the combination group and 54% of those on sunitinib had treatment-related adverse events of grade 3 or 4. Such events led to treatment discontinuation in 5% of the combination group and 8% of the sunitinib group.

Dr. Eric Jonasch, co-author of an accompanying editorial, told Reuters Health by email, "A flurry of immunotherapy/antiangiogenic therapy combinations has recently been published and/or approved for advanced renal-cell carcinoma. Regimens with longer overall survival and higher durable complete response are more likely to benefit patients."

"When held to these standards, the combination of atezolizumab plus bevacizumab may not measure up to the best of the new regimens being approved for advanced renal-cell carcinoma," concluded Dr. Jonasch of The University of Texas MD Anderson Cancer Center in Houston.

Bevacizumab (Avastin) and atezolizumab (Tecentriq) are marketed by Genentech. The study was sponsored by F. Hoffmann-La Roche and Genentech, a member of the Roche Group. Dr. Rini and other authors have relationships with these companies and a number are employees.


Lancet 2019.