Atezolizumab 1200 / Nab-Paclitaxel 100 / Carboplatin 6, nichtkleinzelliges Lungenkarzinom

Protocol-ID: 1238 V2.0 (Complete), ATEZ1200/NPAC100/CRBP6, NSCLC

Indication(s)

Lung Carcinoma, Non-Small Cell (non-squamous); ICD-10 C34.-

Protocol classification

Classification: current standard
Intensity: Standard dose
Therapy mode: First line
Therapy intention: palliative

Cycles

Cycle length 21 days, recommended cycles: 6

Protocol sequences

IMpower130: ATEZ1200/NPAC100/CRBP6, NSCLC (PID1238) -|- ATEZ1200 Erh. (PID1272)

Risks

Emetogenicity (MASCC/ESMO): high (>90%) Carboplatin combination
Emetogenicity (MASCC/ESMO): low (10-30%) Nab-paclitaxel
Neutropenia: very high (>41%) °3-4: 44%
Thrombocytopenia below 50 000/µl: very high (>41%) °3-4: 45%
Anemia Hb below 8g/dl: high (16-30%) °3-4: 29%
Diarrhea: CTC AE °3-4: 5%
Fatigue: CTC AE °3-4: 6%
Nausea: CTC AE °3-4: 3%

Therapy

Day	Substance	Dosage	Appl.	Inf. time	Procedure
HYD Hydration: Balanced Crystalloid Solution
Access: peripheral venous
Hydration before, during, or after antitumor therapy
1	Balanced Crystalloid Solution	500 ml	i.v.	60 min	60 min before Atezolizumab (d1)

8,15	Balanced Crystalloid Solution	500 ml	i.v.	60 min	60 min before Nab-paclitaxel (d8,15)

Day	Substance	Dosage	Solution	Appl.	Inf. time	Procedure
AE Antiemesis: Emetogenicity high (CRBP), FOSAP, GRAN i.v., DEXA i.v.
Access: peripheral venous
DGHO 2016, DKG 2016, MASCC/ESMO 2016, carboplatin-containing combination therapies
1	Fosaprepitant	150 mg	NaCl 0.9% 150 ml	i.v.	20 min	30 min before Atezolizumab (d1)
1	Dexamethasone	12 mg	NaCl 0.9% 50 ml	i.v.	5 min	30 min before Atezolizumab (d1)
1	Granisetron	1 mg	NaCl 0.9% 50 ml	i.v.	5 min	15 min before Atezolizumab (d1)
8,15	Granisetron	1 mg	NaCl 0.9% 50 ml	i.v.	5 min	15 min before Nab-paclitaxel (d8,15)

Day	Substance	Dosage	Solution	Appl.	Inf. time	Procedure
CTX Antineoplastic therapy: ATEZ1200/NPAC100/CRBP6
Access: peripheral venous
Atezolizumab, Nab-Paclitaxel, Carboplatin beim nichtkleinzelligen, nichtplattenepithelialen Lungenkarzinom
1	Atezolizumab	1200 mg	NaCl 0.9% 250 ml	i.v.	60 min	Sequence
If the first infusion was well tolerated, the second infusion can be given over 30 minutes.
1,8,15	Nab-paclitaxel	100 mg/m² BSA	none	i.v.	30 min	Sequence
1	Carboplatin	6 AUC	Dextrose 5% 250 ml	i.v.	30 min	Sequence

Substance links

Links to substances are found here.

Concomitant therapy supplements

For highly emetogenic chemotherapy, additional olanzapine is recommended in the acute (day 1) and delayed phases (days 2-4) at a dosing of 5-10 mg per day (NCCN, ESMO, ASCO, Onkopedia; as of 6/24). Granisetron instead of Dexamethasone for antiemesis on days 8 and 15 to avoid immunosuppression and the risk of infection due to Dexamethasone exposure.

Notes

4 or 6 induction cycles were administered, after which patients received atezolizumab as maintenance therapy. Therapy is continued until reduction of clinical benefit or the occurrence of undesirable side effects.

Cycle diagram

Hydration: Balanced Crystalloid Solution

Substance	1	8	15
	Week 1 / d	Week 2 / d	Week 3 / d
Balanced Crystalloid Solution (i.v.)
Balanced Crystalloid Solution (i.v.)

Antiemesis: Emetogenicity high (CRBP), FOSAP, GRAN i.v., DEXA i.v.

Substance	1	8	15
	Week 1 / d	Week 2 / d	Week 3 / d
Fosaprepitant (i.v.)
Dexamethasone (i.v.)
Granisetron (i.v.)
Granisetron (i.v.)

Antineoplastic therapy: ATEZ1200/NPAC100/CRBP6

Substance	1	8	15
	Week 1 / d	Week 2 / d	Week 3 / d
Atezolizumab (i.v.)
Nab-paclitaxel (i.v.)
Carboplatin (i.v.)

Cycles

Cycle length 21 days, recommended cycles: 6

Controls:

Blood count: on day 1 and subsequently weekly
Oxygen saturation at rest and under stress In high-risk patients, lung function, CO2 diffusion capacity, CT thorax if necessary
Hepatitis (A,B,C) screening: anti-HAV IgM, HBs-Ag, anti-HBc, anti-HCV
CMV, EBV, HIV, tuberculosis screening
ECG Gefahr der Entwicklung einer Überleitungsstörung unter Nab-Paclitaxel-Therapie, EKG-Kontrolle alle 3 Zyklen
Day 1: Na⁺, K⁺, Ca²⁺, Mg²⁺
Day 1: Creatinine, glomerular filtration rate (GFR) Carboplatin dose calculation according to AUC and Calvert's formula; for normal renal function, expect a maximum GFR of 125 ml/min to avoid overdoses.
Day 1: GOT, GPT, GGT, Bilirubin, AP, Cholinesterase
Day 1: Lipase
Day 1: Troponin T, CK, LDH
Day 1: TSH, fT4, cortisol basal, blood glucose (HbA1c) optional and especially if clinically suspected: fT3, ACTH, DHEA-S, IGF1, prolactin, LH/FSH, estradiol (in women), every 6 weeks to 3 months after the end of immunotherapy and every 3 months thereafter.
Day 1: Urine status

Original indication

non-small cell lung cancer, adeno-, stage IV, first line, ECOG 0-1

Original author

West H (2019)

Origin

Thoracic Oncology Program, Swedish Cancer Institute, Seattle, USA, IMpower130

References

West H, Atezolizumab in combination with carboplatin plus nab-paclitaxel chemotherapy compared with chemotherapy alone as first-line treatment for metastatic non-squamous non-small-cell lung cancer (IMpower130): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol 2019 Jul;20(7):924-937. doi: 10.1016/S1470-2045(19)30167-6. PMID: 31122901. [PMID]
Arbour KC, Impact of Baseline Steroids on Efficacy of Programmed Cell Death-1 and Programmed Death-Ligand 1 Blockade in Patients With Non-Small-Cell Lung Cancer. J Clin Oncol 2018 Oct 01;36(28):2872-2878. doi: 10.1200/JCO.2018.79.0006. PMID: 30125216. [PMID]

Recommendations

01/2023: European Society for Medical Oncology
02/2024: National Comprehensive Cancer Network

Status

Valid since 2025-07-08, Version 2.0, last updated 2025-07-08

Last modification: V2.0: Korrektur der Reihenfolge Nab-Paclitaxel-Carboplatin entsprechend der Zulassung. V1.2: Hinzunahme des Kortikosteroids unter Immuntherapie V1.1: Cato Test erfolgt. Entfernen des Kortikosteroids nach Della Corte 2019 / Arbour 2018, Ersatz von Granisetron durch Palonosetron während der Immuntherapie. V1.0: Cato Test erfolgt. V0.1: Laufzeiten nach Fachinfo.

Important notice

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