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Adding atezolizumab to bevacizumab-chemotherapy slowed progression but did not lengthen survival overall; it did help patients with non-epithelioid tumours.
BEAT-meso, ETOP trial 13-18, NCT03762018, sponsored by ETOP and reported at ASCO 2024, tested adding atezolizumab to bevacizumab plus carboplatin and pemetrexed as first-line treatment for advanced pleural mesothelioma, and found that it slowed progression but did not lengthen survival overall, though it did help patients with non-epithelioid tumours. It randomised 400 patients, missed its primary overall survival endpoint in the whole population, improved progression-free survival, and showed a survival benefit in the pre-specified non-epithelioid subgroup with a clear interaction by histology. OnCo links it to mesothelioma, atezolizumab, pemetrexed, the epithelioid versus sarcomatoid term and the ETOP IBCSG Partners Foundation, and the non-epithelioid finding echoes CheckMate 743. Whether histology should now decide who gets immunotherapy in mesothelioma is the open question.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
400 enrolled.
Not significant; primary endpoint not met
SourcePre-specified histology subgroup; interaction p = 0.012 (epithelioid HR 1.01, 95% CI 0.77-1.32)
Source| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Overall survivalprimary | Atezolizumab + bevacizumab + carboplatin-pemetrexed | 200 | 20.5 months | 0.84 (0.66 to 1.06) | 0.14 | link |
| Bevacizumab + carboplatin-pemetrexed | 200 | 18.1 months | ||||
| Progression-free survival | Atezolizumab + bevacizumab + carboplatin-pemetrexed | - | 9.2 months | 0.72 (0.59 to 0.89) | 0.0021 | link |
| Bevacizumab + carboplatin-pemetrexed | - | 7.6 months | ||||
| Overall survival, non-epithelioid histology | Atezolizumab + bevacizumab + carboplatin-pemetrexed | - | Pre-specified histology subgroup; interaction p = 0.012 (epithelioid HR 1.01, 95% CI 0.77-1.32) | 0.51 (0.32 to 0.8) | - | link |
| Bevacizumab + carboplatin-pemetrexed | - | - |
Shares Epithelioid vs sarcomatoid (biphasic) mesothelioma, Mesothelioma, Pemetrexed, Immune checkpoint inhibitors.
Shares Epithelioid vs sarcomatoid (biphasic) mesothelioma, Mesothelioma, Pemetrexed, Immune checkpoint inhibitors.
Shares Epithelioid vs sarcomatoid (biphasic) mesothelioma, Mesothelioma, Pemetrexed, Immune checkpoint inhibitors.
Shares Atezolizumab, Pemetrexed, Immune checkpoint inhibitors.
Shares Mesothelioma, Pemetrexed.
Shares Mesothelioma, Immune checkpoint inhibitors.
Shares Atezolizumab, Immune checkpoint inhibitors.