A trial of atezolizumab for non small cell lung cancer (BIRCH)

Cancer type:

Lung cancer

Non small cell lung cancer

Status:

Results

Phase:

Phase 2

This trial was for people with non small cell lung cancer (NSCLC) that had either:

grown into the surrounding tissues (locally advanced)
spread to other parts of the body (advanced)

It was for people who had certain proteins (receptors) called PD-L1 on the surface of their cancer cells. This is called PD-L1 positive.

More about this trial

This trial started in 2014 and doctors looked at these results in 2015. Researchers were looking for a different way to treat people with advanced NSCLC.

Treatment for advanced NSCLC aims to control the cancer for as long as possible and help with symptoms. Chemotherapy and radiotherapy were possible treatments at the time this trial was done.

Atezolizumab (previously known as MPDL3280A) is a type of immunotherapy. It blocks a protein called PD-L1 on the surface on cancer cells. This helps the immune system Open a glossary item to find and kill cancer cells.

Everyone who took part had atezolizumab for as long as it helped them and the side effects weren’t too bad.

The main aim of this trial was to find out how well atezolizumab works for people with advanced lung cancer and what the side effects are.

Summary of results

667 people took part in this international phase 2 trial. Some people left the trial before it ended. So, doctors looked at the results of 659 people.

Doctors put everyone into 3 groups depending on their previous cancer treatment. There was:

139 people who were having treatment for advanced NSCLC for the first time (group 1)
276 people whose cancer got worse during or after treatment with platinum chemotherapy (group 2)
253 people whose cancer got worse during or after treatment with more than 2 different chemotherapy treatments and one was with a platinum chemotherapy (group 3)

Everyone had atezolizumab every 3 weeks. This continued for as long as it was helping them and the side effects weren’t too bad.

Results

The trial team looked at how well atezolizumab worked. To do this they looked at the number of people who had no signs of their cancer (complete response) or whose cancers shrank (partial response) after treatment with atezolizumab.

They also wanted to know if the number of people whose cancers shrank or disappeared was different based on whether they had high or low levels of PD-L1.

They found that, in people with higher levels of PD-L1:

17 out of 65 people (26%) from group 1 had a complete or partial response
29 out of 122 people (24%) from group 2 had a complete or partial response
31 out of 115 people (27%) from group 3 had a complete or partial response

In people with lower levels of PD-L1:

27 out of 139 people (20%) from group 1 had a complete or partial response
46 out of 267 people (17%) from group 2 had a complete or partial response
44 out of 253 people (17%) from group 3 had a complete or partial response

The trial team also looked at the average length of time that people who had a complete or partial response lived without any signs of their cancer getting worse.

That found that, in people with higher levels of PD-L1, it was about 7 months for people in group 3. Doctors could not look at these results for people in group 1 or group 2. This was because their cancer did not get worse by the time doctors looked at the results.

People with lower levels of PD-L1 and whose cancers shrank or disappeared, lived about 8 and a half months without any signs of their cancer getting worse.

Side effects

The trial team looked at the most common side effects from treatment that people had. Side effects included:

tiredness (fatigue)
decreased appetite
cough
difficulty breathing
feeling sick (nausea)

Conclusion

The researchers were able to learn more about atezolizumab as a treatment for advanced NSCLC that had tested positive for PD-L1.

Doctors look at the results of many studies to decide which drugs work best and are safe for people. Other studies with atezolizumab are going on to help doctors be sure of how well this treatment works.

We have based this summary on information from the research team. The information they sent us has been reviewed by independent specialists (peer reviewed Open a glossary item

) and published in a medical journal. The figures we quote above were provided by the trial team who did the research. We have not analysed the data ourselves.