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

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: 10

Protocol sequences

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

Risks

• Emetogenicity (MASCC/ESMO): high (>90%)
• Neutropenia: high (21-40%) °3-4: 32%
• 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

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).

Notes

Therapy is provided until clinical benefit is diminished or undesirable side effects occur. The risk data refer to the overall protocol.

Controls:

• Blood count: on day 1 and subsequently weekly
• Day 1: Blood sugar Risk of immune-mediated endocrinopathies.
• 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: Na⁺, K⁺, Ca²⁺, Mg²⁺
• Day 1: Glomerular Filtration Rate (GFR) Risk of immune-mediated nephritis
• Day 1: GOT, GPT, GGT, Bilirubin, AP, Cholinesterase Risk of immune-mediated hepatitis

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]

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.

The protocols may not be changed in terms of content.

Diagnosis, indication for therapy and treatment of malignant diseases must be carried out in each individual case by the hematologist and oncologist on his or her own responsibility. The treating physician is obligated to this personal responsibility to weigh in each case before a diagnostic or therapeutic measure, indication, contraindications, dosage and application under consideration of the specialized information or other documents of the manufacturers. This applies in particular to rarely used preparations or preparations that are new to the market.

The publishers and authors assume no liability for the accuracy of the contents. The application is at the own responsibility of the treating physician. ©Onkopti.