Atezolizumab 1200 / Carboplatin 6 / Nab-Paclitaxel 100, Non-Small Cell Lung Cancer
Protocol-ID: 1238 V1.2 (Complete), 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): 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
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.
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.
Cycle diagram
Hydration: Balanced Crystalloid Solution
| Week 1 / d | Week 2 / d | Week 3 / d | Substance | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Balanced Crystalloid Solution (i.v.) | |||||||||||||||||||||
| Balanced Crystalloid Solution (i.v.) | |||||||||||||||||||||
Antiemesis: Emetogenicity high (CRBP), FOSAP, GRAN i.v., DEXA i.v.
| Week 1 / d | Week 2 / d | Week 3 / d | Substance | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Fosaprepitant (i.v.) | |||||||||||||||||||||
| Dexamethasone (i.v.) | |||||||||||||||||||||
| Granisetron (i.v.) | |||||||||||||||||||||
| Granisetron (i.v.) | |||||||||||||||||||||
Antineoplastic therapy: ATEZ1200/CRBP6/NPAC100
| Week 1 / d | Week 2 / d | Week 3 / d | Substance | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Atezolizumab (i.v.) | |||||||||||||||||||||
| Carboplatin (i.v.) | |||||||||||||||||||||
| Nab-paclitaxel (i.v.) | |||||||||||||||||||||
Cycles
Cycle length 21 days, recommended cycles: 6
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 indication
non-small cell lung cancer, adeno-, stage IV, first line, ECOG 0-1
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]
- 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
Status
Valid since 2024-02-15, Version 1.2, last updated 2024-02-15
Last modification: V1.2: Addition of the corticosteroid under immunotherapy V1.1: Cato test done. Removal of corticosteroid according to Della Corte 2019 / Arbour 2018, replacement of Granisetron with Palonosetron during immunotherapy. V1.0: Cato test done. V0.1: Runtimes according to summary of product characteristics.
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.
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