ATTLAS, IMpower151 and ORIENT-31: Dusting off IMpower150 for Post-Osimertinib in EGFR-Mutated NSCLC?

Figures & data

Table 1 Comparison of IMpower150, ATTLAS and ORIENT-31 Trials

Trial	IMpower150	IMpower151	ATTLAS (KCSG-LU19-04)	ORIENT-31
Country	26 countries	China	Korea	China
Treatment arm	Atezolizumab plus bevacizumab and chemotherapy (ABCP, N=34)	Atezolizumab plus bevacizumab and chemotherapy (ABCP, N=81)	Atezolizumab plus bevacizumab and chemotherapy (N=154)	Sintilimab plus IB305 plus chemotherapy (N=158)
Comparator arm	Atezolizumab plus carboplatin plus paclitaxel (ACP, N=45)	Bevacizumab and chemotherapy (BCP, N=82)	Paclitaxel and carboplatin (N=74)	Sintilimab plus chemotherapy (N=156)
	Bevacizumab plus carboplatin plus paclitaxel (BCP, N=43)			Chemotherapy alone (N=160)
EGFR mutation (N)
Exon 19 deletion	15	50	70	80
Exon 21 L858R	11	26	75	70
T790M	1	14	NA	NA
Other	7	5	2	8
Post-3G TKI alone (quad arm)	0%	17.9% (N=14)	8.2% (N=12)	11% (N=7)
Smoking
Current or former	14	NA for subgroup analysis	57	47
Never	20		97	111
Brain metastasis (N)	NA for subgroup analysis	NA for subgroup analysis	67	59
Primary endpoint	PFS and interim OS in the ITT wild-type population (excluding EGFR or ALK alteration)	Investigator-assessed PFS in the ITT population	Investigator-assessed PFS	IRRC-assessed PFS
Efficacy endpoints
ORR	42%	NA for subgroup analysis	69.5%	45%
Median PFS (months)	10.2 (HR, 0.61, 95% CI: 0.36–1.03)	8.5 (HR 0.86, 95% CI: 0.61–1.21)	8.48 (HR 0.62, 95% CI: 0.45–0.86)	7.2 (HR 0.74, 95% CI: 0.57–0.97)
Median OS (months)	NR (HR 0.61, 95% CI: 0.29–1.28)	NA for subgroup analysis	20.63 (HR 1.01, 0.69–1.46)	21.1 (95% CI: 17.5–23.9)
Grade 3 or worse TRAEs	64%		53%	56%
Approvals
FDA	No		No	No
EMA	Yes		No	No

Abbreviations: CI, confidence interval; EGFR, epidermal growth factor receptor; EMA, European Medicines Agency; FDA, Food and Drug Administration; HR, hazard ratio; IC, immune cells; IRRC, independent radiologic review committee; intention-to-treat, ITT; N, number; NA, not applicable; NR, not reached; ORR, objective response rate; OS, overall survival; PD-L1; programmed death-ligand 1; PFS, progression-free survival; TC, tumor cells; TRAEs, treatment-related adverse events.

Figure 1 A hypothetical schema comparing the quad regimen of MARIPOSA-2 to the quad regimen of IMpower151/ATTLAS.