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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

Risks

  • Emetogenicity (MASCC/ESMO): low (10-30%) Nab-paclitaxel
  • Emetogenicity (MASCC/ESMO): high (>90%) Carboplatinkombination
  • 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

HYD
Hydration: Balanced Crystalloid Solution
Access: peripheral venous
Hydration before, during, or after antitumor therapy
DaySubstanceDosageSolutionAppl.Inf. timeProcedure
Balanced Crystalloid Solution 500 ml   i.v.60 min60 min before Atezolizumab (d1) 
8,15 Balanced Crystalloid Solution 500 ml   i.v.60 min60 min before Nab-paclitaxel (d8,15) 
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
DaySubstanceDosageSolutionAppl.Inf. timeProcedure
Fosaprepitant 150 mg NaCl 0.9% 150 ml i.v.20 min30 min before Atezolizumab (d1) 
Dexamethasone 12 mg NaCl 0.9% 50 ml i.v.5 min30 min before Atezolizumab (d1) 
Granisetron 1 mg NaCl 0.9% 50 ml i.v.5 min15 min before Atezolizumab (d1) 
8,15 Granisetron 1 mg NaCl 0.9% 50 ml i.v.5 min15 min before Nab-paclitaxel (d8,15) 
CTX
Medical tumor therapy: ATEZ1200/CRBP6/NPAC100
Access: peripheral venous
Atezolizumab, carboplatin, and nab-paclitaxel in non-small cell, non-plate epithelial lung cancer
DaySubstanceDosageSolutionAppl.Inf. timeProcedure
Atezolizumab 1200 mg NaCl 0.9% 250 ml i.v.60 minSequence 
If the first infusion was well tolerated, the second infusion can be given over 30 minutes.
Carboplatin 6 AUC Dextrose 5% 250 ml i.v.30 minSequence 
1,8,15 Nab-paclitaxel 100 mg/m² BSA none  i.v.30 minSequence 

Concomitant therapy supplements

Granisetron in place of Dexamethasone for antiemesis on days 8 and 15 to avoid immunosuppression and the risk of infection from 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 May 20; [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 10 01;36(28):2872-2878 [PMID]

Recommendations

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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