The purpose of this study is to investigate the safety and efficacy of giving atezolizumab
combined with bevacizumab in patients with stage 4 epidermal growth factor receptor (EGFR)
mutant non‐small cell lung cancer (NSCLC) whose cancer has gotten worse while receiving
This study will be single arm, open label, phase 2 study which will include patients with
stage 4 NSCLC patients with EGFR mutations and who have progressed on osimertinib.
Although both atezolizumab and bevacizumab are approved for the treatment of NSCLC, the
combination of atezolizumab and bevacizumab has not been approved by the FDA for the
treatment of specific non-small cell lung cancer (NSCLC).
Patients who have one of the following EGRF mutations: exon 19 or exon 21 L858R with
progressive disease on osimertinib may be eligible to participate in this study. If enrolled
into the study, the study team will give the patient atezolizumab (1200 mg) combined with
bevacizumab (15 mg/kg) every 3 weeks intravenously. As part of this study, the patient will
have blood samples, other tests, exams, and procedures done for study purposes and their
standard of care. Patient participation in the study will last for up to 2 years after
completion of the last dose of the study drug or until your condition worsens or intolerable
adverse events as deemed by the study doctor.
There are possible patient risks to this study that include but are not limited to diarrhea,
itching, rash, and a feeling of weakness.
1. Age ≥18 years
2. Histologic documentation of primary lung carcinoma, non‐squamous histology with EGFR
exon deletion 19 or exon 21 L858R mutation
3. Stage IV disease according to the 8th Edition of the American Joint Committee on
Cancer staging system
4. Disease progression on osimertinib
5. Eastern Cooperative Oncology Group (ECOG) Performance Status 0 or 1 (appendix 1)
6. Measureable disease as defined by RECIST 1.1 (appendix 2)
7. The following laboratory values obtained ≤ 30 days prior to starting study therapy
1. ANC ≥ 1, 500 / mm3
2. Platelet count, ≥ 100,000 / mm3
3. Hemoglobin ≥ 9.0 g / dL
4. Total bilirubin ≤ 1.5 x upper limit of normal (ULN)
5. Serum Glutamic Oxaloacetic Transaminase (SGOT) (Aspartate Aminotransferase, AST)
and Serum Glutamic Pyruvic Transaminase (SGPT) (Alanine Aminotransferase, ALT)
≤2.5 x ULN in patients without liver or bone metastases; < 5 x ULN in patients
with liver or bone metastases.
6. Cockcroft‐Gault calculated creatinine clearance of ≥ 45 ml/min (appendix 3) or
creatinine ≤1.5 x ULN
7. Urine protein/creatinine (UPC) ratio ≤1.
8. Negative pregnancy test done ≤7 days (or per institutional policy) prior to start of
study therapy, for women of childbearing potential only. Female subjects should be
using highly effective contraceptive measures, and must have a negative pregnancy test
of must have evidence of non‐child bearing potential by fulfilling one of the
following criteria at screening:
1. Post‐menopausal defined as aged more than 50 years and amenorrheic for at least
12 months following cessation of all exogenous hormonal treatments;
2. Women under 50 years of age would be considered post‐menopausal if they have been
amenorrheic for 12 months or more following cessation of exogenous hormonal
treatments and Luteinizing hormone (LH) and follicle-stimulating hormone (FSH)
levels in the post‐menopausal range for the institution;
3. Documentation of irreversible surgical sterilization by hysterectomy, bilateral
oophorectomy or bilateral salpingectomy but not tubal ligation.
9. Male subjects should be willing to use barrier contraception.
10. Provide informed written consent
1. Mixed, non‐small cell and small cell tumors or mixed adenosquamous carcinomas with a
predominant squamous component.
2. Any of the following because this study involves an investigational agent whose
genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are
unknown: pregnant women, nursing women, men or women of childbearing potential who are
unwilling to employ adequate contraception
3. Other active malignancy ≤ 2 years prior to study cycle 1 day 1 of study therapy.
EXCEPTIONS: Nonmelanotic skin cancer or carcinoma‐in‐situ of the cervix, or adequately
treated stage I or II cancer. NOTE: If there is a history of prior malignancy, they
must not be receiving other specific treatment (i.e. hormonal therapy) for their
4. History of myocardial infarction or other evidence of arterial thrombotic disease
(angina), symptomatic congestive heart failure (New York Heart Association ≥ grade 2),
unstable angina pectoris, or ventricular arrhythmia with ≤ 6 months
5. History of cerebral vascular accident (CVA) or transient ischemic attack (TIA) ≤ 6
months prior to study cycle 1 day 1 of study therapy.
6. History of bleeding diathesis or coagulopathy.
7. Inadequately controlled hypertension (systolic blood pressure of >160 mmHg or
diastolic pressure >100 mmHg on anti‐hypertensive medications). Note: History of
hypertensive crisis or hypertensive encephalopathy not allowed.
8. Serious non‐healing wound, ulcer, bone fracture, or have undergone a major surgical
procedure, open biopsy, or significant traumatic injury ≤ 28 days or core biopsy ≤ 7
days prior to starting therapy
9. History of abdominal fistula, gastrointestinal perforation, or intraabdominal abscess
≤6 months prior to study cycle 1 day 1 of study therapy.
10. Known hypersensitivity to Chinese hamster ovary cell products or other recombinant
11. History of hemoptysis ≥ grade 2 (defined as bright red blood of at least 2.5 mL) ≤ 3
months prior to cycle 1 day 1 of study therapy.
12. Symptomatic untreated brain metastases which is defined as persistent neurological
symptoms or requiring ongoing use of steroids. Asymptomatic untreated brain metastases
are allowed if ≤ 1 cm
13. Significant vascular disease (e.g. aortic aneurysm surgical repair or recent
peripheral arterial thrombosis) ≤6 months prior to starting study therapy
14. Radiotherapy to any site for any reason ≤ 14 days prior to study cycle 1 day 1 of
15. Pre‐existing and clinically active interstitial lung disease
16. Autoimmune condition requiring ongoing or intermittent systemic treatment.
Participants with a condition requiring systemic treatment with either corticosteroids
(>10 mg daily prednisone equivalent) or other immunosuppressive medications within 14
days of study treatment initiation. Inhaled or topical steroids, and adrenal
replacement steroid > 10 mg daily prednisone equivalent, are permitted in the absence
of active autoimmune disease.
Participants with type I diabetes mellitus, hypothyroidism only requiring hormone
replacement, skin disorders (such as vitiligo, psoriasis, or alopecia) not requiring
systemic treatment, or conditions not expected to recur in the absence of an external
trigger are permitted to enroll.
17. Prior therapy with anti‐PD‐1 or anti‐PD‐L1 immunotherapy,
18. Prisoners, participants who are involuntarily incarcerated, or participants who are
compulsorily detained for treatment of either a psychiatric or physical (e.g.,
infectious disease) illness