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Proffered Paper session - NSCLC, metastatic

LBA67 - A phase III, randomized study of atezolizumab plus bevacizumab and chemotherapy in patients with EGFR or ALK mutated in non-small cell lung cancer (ATTLAS, KCSG-LU19-04)


20 Oct 2023


Proffered Paper session - NSCLC, metastatic


Tumour Site

Non-Small Cell Lung Cancer


Myung-Ju Ahn


Annals of Oncology (2023) 34 (suppl_2): S1254-S1335. 10.1016/S0923-7534(23)04149-2


M. Ahn1, S. Park2, T.M. Kim3, J. Han4, G. Lee5, B. Shim6, Y. Lee7, S. Kim8, I. Kim9, S. Lee10, Y.J. Kim11, J.H. Park12, S.G. Park13, K.H. Lee14, E.J. Kang15, J.W. Kim16, S. Shin17

Author affiliations

  • 1 Hematology-oncology Department, Samsung Medical Center (SMC) - Sungkyunkwan University School of Medicine, 135-710 - Seoul/KR
  • 2 Hematology And Medical Oncology, Samsung Medical Center, 06615 - Seoul/KR
  • 3 Internal Medicine Department, Seoul National University - College of Medicine - Yeongeon Medical Campus, 03080 - Seoul/KR
  • 4 Center For Lung Cancer, National Cancer Center - Graduate School of Cancer Science and Policy, 10408 - Goyang/KR
  • 5 Internal Medicine Dept., Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, 660 702 - Jinju/KR
  • 6 Medical Oncology Dept., The Catholic University of Korea - St. Vincent's Hospital, 442-723 - Suwon/KR
  • 7 Internal Medicine Department, Samsung Medical Center (SMC)-Kangbuk Samsung Hospital, 03181 - Seoul/KR
  • 8 Oncology Dept., Asan Medical Center - University of Ulsan, 138-931 - Seoul/KR
  • 9 Medical Oncology Department, Inje University Haeundae Paik Hospital, 612-896 - Busan/KR
  • 10 Internal Medicine, Dong-A University Medical Center, 602-715 - Busan/KR
  • 11 Internal Medicine Department, SNUBH - Seoul National University Bundang Hospital, 13620 - Seongnam/KR
  • 12 Medical Oncology Department, Konkuk University Medical Center, 05030 - Seoul/KR
  • 13 Internal Medicine, Chosun University Hospital, 501-717 - Gwangju/KR
  • 14 Internal Medicine Department, Chungbuk National University Hospital, 361-711 - Cheongju/KR
  • 15 Department Of Internal Medicine, Korea University Guro Hospital, 08308 - Seoul/KR
  • 16 Department Of Hemato-oncology, Korea University Anam Hospital, 136 705 - Seoul/KR
  • 17 Department Of Internal Medicine, Kosin Univeristy Gospel Hospital, 602-702 - Busan/KR


This content is available to ESMO members and event participants.

Abstract LBA67


In the treatment ofnon-small cell lung cancer (NSCLC) with a driver mutation, the role of anti-PD-(L)1 antibody following tyrosine kinase inhibitor (TKI) remains unclear. This randomized, open-label, multicenter, phase 3 study evaluates the efficacy of atezolizumab plus bevacizumab and chemotherapy in EGFR or ALK-mutated NSCLC that progressed prior to TKI therapy.


We compared the clinical efficacy of atezolizumab plus bevacizumab/paclitaxel/carboplatin (ABCP arm) followed by maintenance therapy with atezolizumab plus bevacizumab with pemetrexed plus carboplatin or cisplatin (PC arm) followed by pemetrexed maintenance. The primary endpoint was progression-free survival (PFS).


A total of 228 patients with activating EGFR mutation (n=215) or ALK translocation (n=13) were enrolled from 16 sites in the Republic of Korea and randomized at 2:1 ratio of either ABCP (n=154) or PC arm (n=74). The median follow-up duration was 26.1 months (95% CI 24.7-28.2). Objective response rates were higher in the ABCP arm than in the PC arm (69.5% vs 41.9%, P <0.001). Median PFS was significantly longer in the ABCP than in the PC arm (8.48 months vs. 5.62 months, hazard ratio [HR] 0.62 [0.45-0.86], P=0.004). PFS benefit increased as PD-L1 expression increased, with HR of 0.47, 0.41, and 0.24 for PD-L1 ≥1%, ≥10% and ≥50%, respectively. Overall survival was similar between ABCP and PC (20.63 months vs. 20.27 months, HR 1.01 [0.69-1.46], P=0.975). The safety profile of the ABCP arm was comparable to that previously reported, with no additional safety signals.


This study is the first randomized phase 3 study to demonstrate the clinical benefit of anti-PD-L1 antibody in combination with bevacizumab and chemotherapy in EGFR or ALK mutated NSCLC who have progressed on relevant targeted therapy.

Clinical trial identification


Editorial acknowledgement

This study is under consideration of simultaneous publication in Journal of Clinical Oncology and it is pre-discussed with JCO editorial board.

Legal entity responsible for the study

Myung-Ju Ahn.




All authors have declared no conflicts of interest.

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