Quality of Life Outcomes from the Phase 3 Study of Atezolizumab plus Bevacizumab and Chemotherapy (ATTLAS, KCSG-LU19-04) in EGFR/ALK-Mutated NSCLC

초록

Introduction: In the phase 3 ATTLAS study, the combination of atezolizumab with bevacizumab, paclitaxel, and carboplatin (ABCP), followed by maintenance therapy with atezolizumab plus bevacizumab, demonstrated longer progression-free survival and no new safety concerns compared to pemetrexed plus carboplatin or cisplatin (PC), followed by pemetrexed maintenance, in EGFR- or ALK-mutated NSCLC following tyrosine kinase inhibitor (TKI) failure. Here, we report patient-reported quality of life (QoL) outcomes from this trial. Methods: Patients received intravenous treatment every 3 weeks until disease progression or loss of clinical benefit. The ABCP regimen consisted of atezolizumab (1,200 mg), bevacizumab (15 mg/kg), paclitaxel (175 mg/m2), and carboplatin (AUC 5 or 5.5). The PC arm included pemetrexed (500 mg/m2) with either carboplatin (AUC 5.0) or cisplatin (70 mg/m2). Health-related QoL was assessed at each cycle using the EORTC QLQ-C30 and QLQ-LC13 questionnaires. Key endpoints included changes in global health status/QoL (GHS/QoL) from baseline to weeks 9 and 24, and the median time to deterioration (TTD), defined as a ≥10-point decline in GHS/QoL. Results: Of 228 patients randomized (2:1), 146 in the ABCP arm and 68 in the PC arm completed at least one QoL assessment. Baseline GHS/QoL scores were similar across arms. The ABCP group showed a slightly greater early decline in GHS and physical functioning scores, but both arms demonstrated trends toward improvement by week 24. Differences in the least squares (LS) mean scores were not statistically significant (Week 9: −4.66 [95% CI, −12.57 to 3.26], P = 0.247; Week 24: −7.39 [−21.72 to 6.94], P = 0.305). QLQ-LC13 results showed more neuropathy, alopecia, and pain in the ABCP arm, suggesting greater treatment-related toxicity. However, cancer-related symptoms (e.g., coughing, hemoptysis, dyspnea) improved more in the ABCP group. Median TTD for GHS/QoL did not differ significantly between arms (P = 0.160). Conclusions: Despite toxicity-related functional impairment in the ABCP group, overall QoL was not significantly worse compared to the PC group. Improvements in cancer-related symptoms and stable GHS/QoL suggest that ABCP treatment may help maintain QoL while offering survival benefits with appropriate toxicity management.