Disproportionality analysis of adverse events in advanced lung cancer treated with atezolizumab plus platinum-based...

Advanced non-squamous non-small cell lung cancer has a poor prognosis, and immune checkpoint inhibitors (ICIs) plus platinum-based combination chemotherapy is the first-line treatment. Atezolizumab, an ICI, has three regimens: atezolizumab + carboplatin (CBDCA) + paclitaxel + bevacizumab [ABCP], atezolizumab + CBDCA + nab-paclitaxel (nab-PTX) [A + CnP], and atezolizumab + CBDCA + pemetrexed [A + CbP]. However, clinical trials directly comparing these regimens have not been reported, and the differences in adverse events have not been fully clarified.

We calculated the reporting odds ratio (ROR), a measure of adverse drug reaction (ADR) signals, using the FDA Adverse Event Reporting System (FAERS) to compare the major ADRs of ABCP, A + CnP, and A + CbP regimens.

The ROR (95% confidence interval [CI]) for rash and hypersensitivity-related adverse events was 2.06 (1.81-2.34) for ABCP, 0.81 (0.42-1.56) for A + CnP, and 0.57 (0.37-0.87) for A + CbP; the signal was only detected for the ABCP regimen. In acute kidney injury (AKI), it was ABCP: 1.24 (0.89-1.73), A + CnP: 1.16 (0.37-3.60), and A + CbP: 1.76 (1.06-2.93), and signal was detected only for the A + CbP regimen. Contrarily, signals were detected for colitis, drug-induced liver injury, and pneumonitis for all regimens.

Rash and hypersensitivity-related adverse events and AKI were more frequently reported with the ABCP and A + CbP regimens, respectively. These observations may help generate hypotheses regarding regimen-specific adverse event profiles and support future studies toward individualized chemotherapy.