Atezolizumab 1200 / Carboplatin 6 / Nab-Paclitaxel 100, Non-Small Cell Lung Cancer

Protocol-ID: 1238 V1.2 (Standard), ATEZ1200/CRBP6/NPAC100, NSCLC

Indication(s)

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

Protocol classification

Classification: alternative
Intensity: Standard dose
Therapy mode: First line
Therapy intention: palliative

Cycles

Cycle length 21 days, recommended cycles: 6

Protocol sequences

IMpower130: ATEZ1200/CRBP6/NPAC100, NSCLC (PID1238) -|- ATEZ1200/CRBP6/NPAC100 - ATEZ1200 maint. (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/CRBP6/NPAC100
Access: peripheral venous
Atezolizumab, carboplatin, and nab-paclitaxel in non-small cell, non-plate epithelial lung cancer
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	Carboplatin	6 AUC	Dextrose 5% 250 ml	i.v.	30 min	Sequence
1,8,15	Nab-paclitaxel	100 mg/m² BSA	none	i.v.	30 min	Sequence

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.

Controls:

Blood count: on day 1 and subsequently weekly
Echocardiography, ECG Nab-paclitaxel: monitoring for cardiac events, cases of left ventricular dysfunction and congestive heart failure occurred.
Day 1: TSH, fT3, fT4 Monitor for changes in thyroid function and signs of thyroid disease. Monitor for immune-mediated endocrinopathies at baseline and during therapy.
Day 1: GOT, GPT, GGT, Bilirubin, AP, Cholinesterase Nab-paclitaxel: Liver monitoring before and during therapy, dose adjustment if necessary. Impairment of liver function possible with carboplatin therapy.
Day 1: Glomerular Filtration Rate (GFR) monitor immune-mediated nephritis, Carboplatin dose calculation according to AUC and Calvert's formula; in normal renal function, expect a maximum GFR of 125 ml/min to avoid overdoses.

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

Important notice

The copyrighted protocols are treatment recommendations. The information contained in this compilation on cytostatic drugs, concomitant medication and other therapeutic procedures, as well as dosage and application information, is continuously reviewed with all due care by the authors and editors involved. Nevertheless, the publishers and authors do not assume any liability for the correctness - also with regard to possible printing errors.

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