Health Technology Brief

supporting sound, evidence-based decision making

Atezolizumab (Tecentriq) for Non-Small Cell Lung Cancer

March 5, 2018

Health Problem: Lung cancer is the second most common form of cancer in men (after prostate cancer) and women (after breast cancer), accounting for approximately 14% of all new cancers. Non-small cell lung cancer (NSCLC) accounts for > 80% of all lung cancer cases, and it includes 2 major types: non-squamous, including adenocarcinoma, large-cell carcinoma, and other cell types; and squamous cell (epidermoid) carcinoma. Adenocarcinoma is the most common type of lung cancer seen in the United States and is also the most frequently occurring histology in nonsmokers.

Technology Description: Atezolizumab is an immune checkpoint inhibitor recently developed for the treatment of NSCLC and other tumors. It is a humanized monoclonal antibody that blocks the interaction between the programmed cell death-1 (PD-1) receptor and its ligand, programmed cell death-ligand 1 (PD-L1). When the PD-1 protein, which is expressed on T cells, binds with PD-L1, T-cell function is suppressed. Many tumor types, including NSCLC, also express PD-L1 either on the tumor cells themselves or on immune cells that are infiltrating the tumor. Tumors can exploit the PD-1 pathway by upregulating their production of PD-L1, allowing them to evade natural immune surveillance. By blocking the PD-L1/PD-1 immune checkpoint, atezolizumab reduces immunosuppressive signals found within the tumor cells and allows the T cells to function against the tumor.

Controversy: In patients with previously treated advanced NSCLC, docetaxel has been a standard second-line treatment option for more than a decade. However, docetaxel can cause severe adverse effects.

Key Questions:

  • Is atezolizumab effective in treating NSCLC?
  • How does atezolizumab compare with chemotherapy?
  • Is atezolizumab safe?
  • Have definitive patient selection criteria been identified for atezolizumab?