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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

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.

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]

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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.

Valid since: 15.02.2024