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

Protocol-ID: 1238 V1.2 (Short), 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.

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

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Valid since: 15.02.2024