In patients with EGFR mutant or ALK-positive NSCLC, Tecentriq, in combination with bevacizumab, paclitaxel and carboplatin, is indicated only after failure of appropriate targeted therapies.

...Patients who have received previous adjuvant or neoadjuvant chemotherapy are eligible if the date of last dose of treatment was at least 12 months before randomisation- Known EGFR mutations genotypes by tissue or ctDNA; patients with common mutations (L858R or Del19) and other rare mutations (e.g. S768I, G719X) are eligible- Measurable or evaluable disease by RECIST v1.1- Disease progression (during or after) or unacceptable side effects from prior treatment with at least one EGFR TKI (TKI washout period = 7 days). ...

...- Patients with known targetable mutations in EGFR or BRAF or known translocations in ALK or ROS1 are eligible if they have received FDA approved targeted therapy first....

...- Patient with a sensitizing mutation in the EGFR gene must have experienced disease progression (during or after treatment) or intolerance to treatment with one or more EGFR TKIs, such as erlotinib, gefitinib, osimertinib or another EGFR TKI appropriate for the treatment of EGFR-mutant NSCLC....

...Known EGFR mutations genotypes by tissue or ctDNA, patients with common mutations (L858R or Del19) and other rare mutations (e.g....

...IIIC, or IV non-squamous NSCLC, with the following exceptions: Patients with a sensitizing mutation in the EGFR gene must have experienced disease progression or were intolerant to treatment with one or more EGFR TKIs....

...• Patient older than 18 years and no more than 75 year-old • Subject affiliated to an appropriate social security system • Signed informed consent before any trial related activities and according to local guidelines • ECOG performance status of 0 or 1 • Histologically or cytologically confirmed, stage IIIB/IV non-squamous NSCLC (per the Union Internationale contre le Cancer/American Joint Committee on Cancer staging system, 7th edition) • Patient with a sensitizing mutation in the EGFR gene must have experienced disease progression (during or after treatment) or intolerance to treatment with one or more EGFR TKIs, such as erlotinib, gefitinib, osimertinib or another EGFR TKI appropriate for the treatment of EGFR-mutant NSCLC • Patient with an ALK fusion oncogene (confirmed in local laboratory) must have experienced disease progression (during or after treatment) or intolerance to treatment with one or more ALK inhibitors (i.e., crizotinib, alectinib, ceritinib) appropriate for the treatment of NSCLC in patients having an ALK fusion oncogene • Patient with a ROS1 fusion oncogene (confirmed in local laboratory) must have experienced disease progression (during or after treatment) or intolerance to treatment with one or more ROS inhibitors (i.e., crizotinib,) appropriate for the treatment of NSCLC in patients having an ROS1 fusion oncogene • No prior chemotherapy treatment for Stage IV non-squamous NSCLC except if less than 3 cycles, with treatment free-interval of at least 1 year from inclusion since last chemotherapy • Patient who has received prior neo-adjuvant, adjuvant chemotherapy, radiotherapy, or chemoradiotherapy with curative intent for non-metastatic disease must have experienced a treatment-free interval of at least 6 months from inclusion since the last chemotherapy, radiotherapy, or chemoradiotherapy • Patient with an history of treated asymptomatic CNS metastases is eligible •Measurable disease, as defined by RECIST v1.1 •Adequate hematologic and end-organ function •Adequate method of contraception during the treatment period and at least 5 months after the last dose of atezolizumab or 6 months after the last dose of chemotherapy • Patient âgé de 18 ans et pas plus de 75 ans • Sujet affilié à un système de sécurité sociale • Consentement éclairé signé avant tout acte lié à l'essai • Indice de performance (ECOG) 0-2. ...

...with the following exceptions: (1) Patients with a sensitizing mutation in the EGFR gene must have experienced disease progression (during or after treatment) or were intolerant to treatment with one or more EGFR TKIs, such as erlotinib, gefitinib, afatinib, dacomitinib, and osimertinib, or another EGFR TKI appropriate for the treatment of EGFR-mutant NSCLC....

...- Must have either tumors that harbor an EGFR mutation in exon 19 or exon 21, or must be never smoker wild-types....

...- Patients with a sensitizing mutation in the epidermal growth factor receptor (EGFR) gene must have experienced disease progression (during or after treatment) or intolerance to treatment with one or more EGFR TKIs, such as erlotinib, gefitinib, osimertinib or another EGFR tyrosine kinase inhibitor (TKI) appropriate for the treatment of EGFR mutant NSCLC....

Patients received platinum, pemetrexed, atezolizumab, bevacizumab (PPAB cohort)....EGFR mutation, 87.3%/89.7%; ALK rearrangement, 12.7%/5.1%; ROS1 fusion, 0%/6.4%, respectively)....After 12 weeks, objective response rate was 58.2% (90% confidence interval [CI], 47.4-68.4) in PPAB cohort and 46.5% (90% CI, 36.3-56.9) in PPA cohort. Median progression-free survival and overall survival were 7.3 (95% CI 6.9-9.0) months and 17.2 (95% CI 13.7-NA) months in PPAB cohort and 7.2 (95% CI 5.7-9.2) months and 16.8 (95% CI 13.5-NA) months in PPA cohort, respectively....Combination approach with atezolizumab with or without bevacizumab and platinum-pemetrexed achieved promising activity in metastatic EGFR-mutated or ALK/ROS1-rearranged NSCLC after tyrosine kinase inhibitor failure, with acceptable safety profile.

We conducted a national, open, multicentre, non-randomized Phase II Study with two parallel cohorts: A (Platinum-Pemetrexed-Atezolizumab-Bevacizumab) and B (Platinum-Pemetrexed-Atezolizumab). Main eligibility criteria were: stage IIIB/IV NSCLC with EGFR mutation or ALK/ROS1 rearrangement progression after ≥1 targeted therapy and no prior chemotherapy and eligible for Bevacizumab (A)....Combination approach of Platinum-Pemetrexed-Atezolizumab-Bevacizumab or Platinum-Pemetrexed-Atezolizumab achieved promising efficacy in metastatic EGFR/ALK mutated NSCLC after TKI failure, with acceptable tolerance profile.