A Study of Neoadjuvant Atezolizumab Plus Chemotherapy Versus Placebo Plus Chemotherapy in Patients With Resectable Stage II, IIIA, or Select IIIB Non-Small Cell Lung Cancer (IMpower030)

Study Overview
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Brief Summary
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This is a randomized, double-blinded study designed to evaluate the efficacy, safety, pharmacokinetics, and immunogenicity of neoadjuvant treatment with atezolizumab (MPDL3280A) or placebo in combination with platinum-based chemotherapy in participants with resectable Stage II, IIIA, or select IIIB non-small cell lung cancer (NSCLC) followed by open-label adjuvant/postoperative atezolizumab or best supportive care and monitoring.

Official Title
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A Phase III, Double-Blinded, Multicenter, Randomized Study Evaluating the Efficacy and Safety of Neoadjuvant Treatment With Atezolizumab or Placebo in Combination With Platinum-Based Chemotherapy in Patients With Resectable Stage II, IIIA, or Select IIIB Non-Small Cell Lung Cancer

Conditions
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Non-Small-Cell Lung

Intervention / Treatment
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* Drug: Atezolizumab (MPDL3280A), an engineered anti-PD-L1 antibody
* Drug: Placebo Comparator
* Drug: Nab-paclitaxel
* Drug: Pemetrexed
* Drug: Carboplatin
* Drug: Cisplatin
* Drug: Gemcitabine


Participation Criteria
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Eligibility Criteria
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Inclusion criteria: Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1 Histologically or cytologically confirmed, resectable Stage II, IIIA, or Select IIIB (T3N2 only) NSCLC of squamous or non-squamous histology. Staging should be based on the 8th edition of the AJCC/UICC staging system Evaluation by an attending thoracic surgeon to confirm eligibility for an R0 resection with curative intent Adequate pulmonary and cardiac function to undergo surgical resection Measurable disease as defined by RECIST v1.1 Adequate hematologic and end organ function Negative HIV test at screening Negative for active HBV and HCV at screening Adequate tissue for PD-L1 IHC assessment Exclusion criteria: NSCLC with histology of large cell neuroendocrine carcinoma or sarcomatoid carcinoma Mixed NSCLC and small cell lung cancer histology Any prior therapy for lung cancer Malignancies other than NSCLC within 5 years prior to randomization, with the exception of those with a negligible risk of metastasis or death treated expected curative outcome Non-squamous NSCLC histology with activating ALK and EGFR mutation Pregnant or lactating women History of autoimmune disease History of idiopathic pulmonary fibrosis, organizing pneumonia, drug-induced pneumonitis, or evidence of active of active pneumonitis on screening chest Computed Tomography (CT) scan Prior treatment with cluster of differentiation 137 (CD137) agonist or immune checkpoint blockade therapies, anti-programmed-death-1 (anti-PD-1), and anti-PD-L1 therapeutic antibody Severe infection within 4 weeks prior to randomization Significant history of cardiovascular disease

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Arm A: Atezolizumab + platinum-based chemotherapy<br>Neoadjuvant treatment will consist of 4 cycles; atezolizumab + platinum-based chemotherapy Platinum-based chemotherapy may include: carboplatin + pemetrexed carboplatin + nab-paclitaxel cisplatin + pemetrexed cisplatin + gemcitabine Post-operative adjuvant treatment will consist of 16-cycles of atezolizumab | Drug: Atezolizumab (MPDL3280A), an engineered anti-PD-L1 antibody<br>* Atezolizumab will be administered as intravenous (IV) infusion at a dose of 1200 milligrams (mg) on Day 1 of each 21-day cycle (every 3 weeks) for 4 cycles during the neoadjuvant treatment phase Atezolizumab will be administered as IV infusion at a dose of 1200 milligrams (mg) every 3 weeks for 16 cycles during the post-operative adjuvant phase<br>* Other names: Tecentriq;Drug: Nab-paclitaxel<br>* Nab-paclitaxel 100 mg/m^2 will be administered intravenously on Days 1, 8, and 15 of each 21 day cycle for 4 cycles during the neoadjuvant treatment phase<br>* Other names: Abraxane;Drug: Pemetrexed<br>* Pemetrexed 500 mg/m^2 will be administered intravenously on Day 1 of each 21-day cycle for 4 cycles during the neoadjuvant treatment phase<br>* Other names: Alimta;Drug: Carboplatin<br>* Carboplatin initial target AUC of 6 mg/mL/min will be administered intravenously on Day 1 of each 21-day cycle for 4 cycles during the neoadjuvant treatment phase<br>Drug: Cisplatin<br>* Cisplatin 75 mg/m^2 will be administered intravenously on Day 1 of each 21-day cycle for 4 cycles during the neoadjuvant treatment phase<br>Drug: Gemcitabine<br>* Gemcitabine 1250 mg/m^2 will be administered intravenously on Day 1 and 8 of each 21-day cycle for 4 cycles during the neoadjuvant treatment phase<br>* Other names: Gemzar;|
| Placebo Comparator: Arm B: Placebo + platinum-based chemotherapy<br>Neoadjuvant treatment will consist of 4 cycles; placebo + platinum-based chemotherapy Platinum-based chemotherapy may include: carboplatin + pemetrexed carboplatin + nab-paclitaxel cisplatin + pemetrexed cisplatin + gemcitabine Participants will receive best supportive care and monitoring after surgery | Drug: Placebo Comparator<br>* Placebo will be administered as IV infusion at a dose of 1200 milligrams (mg) on Day 1 of each 21-day cycle for 4 cycles during the neoadjuvant treatment phase<br>Drug: Nab-paclitaxel<br>* Nab-paclitaxel 100 mg/m^2 will be administered intravenously on Days 1, 8, and 15 of each 21 day cycle for 4 cycles during the neoadjuvant treatment phase<br>* Other names: Abraxane;Drug: Pemetrexed<br>* Pemetrexed 500 mg/m^2 will be administered intravenously on Day 1 of each 21-day cycle for 4 cycles during the neoadjuvant treatment phase<br>* Other names: Alimta;Drug: Carboplatin<br>* Carboplatin initial target AUC of 6 mg/mL/min will be administered intravenously on Day 1 of each 21-day cycle for 4 cycles during the neoadjuvant treatment phase<br>Drug: Cisplatin<br>* Cisplatin 75 mg/m^2 will be administered intravenously on Day 1 of each 21-day cycle for 4 cycles during the neoadjuvant treatment phase<br>Drug: Gemcitabine<br>* Gemcitabine 1250 mg/m^2 will be administered intravenously on Day 1 and 8 of each 21-day cycle for 4 cycles during the neoadjuvant treatment phase<br>* Other names: Gemzar;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Independent Review Facility (IRF)-Assessed Event Free Survival (EFS) | IRF-assessed EFS is defined as the time from randomization to the first documented disease progression per RECIST v1.1 that precludes surgery, local or distant disease recurrence, or death from any cause, whichever occurs first. | Up to approximately 96 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pathological Complete Response (pCR) | pCR is defined as the absence of any viable primary tumor cells at the time of surgical resection in the primary tumor and all sampled lymph nodes as assessed by central and local pathology laboratory. | At time of surgery | 
| Major Pathological Response (MPR) | MPR is defined as ≤ 10% residual viable tumor cells at the time of surgical resection in the primary tumor, as assessed by central and local pathology laboratory. | At time of surgery | 
| Objective Response (OR) | Objective response is defined as a complete response or partial response, as determined by the investigator according to RECIST v1.1 | Prior to surgery, up to approximately 84 days | 
| Overall Survival (OS) | OS is defined as the time from randomization to death from any cause during the course of the study. | Up to approximately 96 months | 
| Investigator-Assessed EFS | EFS is defined as the time from randomization to the first documented disease progression per RECIST v1.1 that precludes surgery, local or distant disease recurrence, as assessed by the investigator; or death from any cause, whichever occurs first. | Up to approximately 96 months | 
| Disease-Free Survival (DFS) | DFS is defined as the time from the first date of no disease to local or distant recurrence (including occurrence of new primary NSCLC) or death due to any cause, whichever occurs first, as determined by the investigator during the adjuvant treatment and observation follow-up | Up to approximately 96 months | 
| 2-Year and 3-Year OS | The 2-year and 3-year OS rate is defined as the probability that a participant will be alive 2 years and 3 years after randomization, respectively. | Up to approximately 96 months | 
| 2-Year and 3-Year Independent Review Facility-Assessed EFS | EFS is defined as the probability that a participant will be event-free 2 years and 3 years after randomization, respectively, as assessed by the Independent Review Facility. | Up to approximately 96 months | 
| 2-Year and 3-Year Investigator-Assessed EFS | EFS is defined as the probability that a participant will be event-free 2 years and 3 years after randomization, respectively, as assessed by the Investigator. | Up to approximately 96 months | 
| Change from baseline in HRQoL scores | Change from baseline in HRQoL scores as assessed through use of the two-item GHS/HRQoL subscale (Questions 29 and 30) of the EORTC QLQ-C30 at each assessment time point during the study through the completion of adjuvant treatment and observation follow-up assessments | Up to approximately 96 months | 
| Percentage of Participants With Adverse Events (AEs) |  | Up to approximately 96 months | 
| Number and Severity of Surgical Related Adverse Events |  | Up to approximately 96 months | 
| Number of Surgical Delays | Number of surgical delays. | Up to approximately 96 months | 
| Length of Surgical Delays | Length of surgical delays. | Up to approximately 96 months | 
| Number of Operative and Post-Operative Complications | Number of operative and post-operative complications. | Up to approximately 96 months | 
| Reasons for Surgical Cancellations | Reasons for surgical cancellations. | Up to approximately 96 months | 
| Minimum Observed Serum Atezolizumab Concentration (Cmin) | Cmin is the minimum (or trough) concentration that a study drug achieves in the body. | Pre-dose on Day 1 of Cycles 1 and 3 (each cylce is 21 days) for Neoadjuvant Treatment; pre-dose on Day 1 of Cycles 5, 7, 9, 11 and 19 (each cycle is 21 days) for Arm A; at treatment or observation follow-up discontinuation (up to approximately 96 months) | 
| Maximum Observed Serum Atezolizumab Concentration (Cmax) | Cmax is the maximum (or peak) concentration that a study drug achieves in the body. | Pre-dose on Day 1 of Cycles 1 and 3 for Neoadjuvant Treatment; Pre-dose on Day 1 of Cycles 5, 7, 9, 11 and 19 for Arm A. Each cycle is 21 days; at treatment or observation follow-up discontinuation (up to approximately 96 months) | 
| Percentage of Participants With Anti-Drug Antibody (ADA) to Atezolizumab |  | Pre-dose on Day 1 of Cycles 1 and 3 for Neoadjuvant Treatment; Pre-dose on Day 1 of Cycles 5, 7, 9, 11 and 19 for Arm A. Each cycle is 21 days; at treatment or observation follow-up discontinuation (up to approximately 96 months) |