Atezolizumab 1200 / Carboplatin 6 / Nab-Paclitaxel 100, Non-Small Cell Lung Cancer
Protocol-ID: 1238 V1.2 (Short), ATEZ1200/CRBP6/NPAC100, NSCLCIndication(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%) Carboplatin combination
- 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 | |||||||
Day | Substance | Dosage | Solution | Appl. | Inf. time | Procedure | |
---|---|---|---|---|---|---|---|
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) | ||
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 | |||||||
Day | Substance | Dosage | Solution | Appl. | Inf. time | Procedure | |
---|---|---|---|---|---|---|---|
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) |
CTX Antineoplastic therapy: ATEZ1200/CRBP6/NPAC100 | |||||||
Access: peripheral venous | |||||||
Atezolizumab, carboplatin, and nab-paclitaxel in non-small cell, non-plate epithelial lung cancer | |||||||
Day | Substance | Dosage | Solution | Appl. | Inf. time | Procedure | |
---|---|---|---|---|---|---|---|
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
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Valid since: 15.02.2024