BC Cancer Protocol Summary for Treatment of Advanced Non-
Small Cell Lung Cancer Using Atezolizumab
Protocol Code LUAVATZ
Tumour Group Lung
Contact Physician Dr. Barb Melosky
ELIGIBILITY:
Patients must have:
Advanced non-small cell lung cancer, irrespective of histology, and
Disease progression on or after prior platinum-based chemotherapy requiring
second- or subsequent-line therapy
Note:
CAP approval is not required to switch between LUAVATZ and LUAVATZ4.
In the advanced setting, patients are eligible to receive one of atezolizumab,
nivolumab or pembrolizumab, but not sequential use of these agents
Patients should have:
Good performance status (ECOG 0-2)
Adequate hepatic and renal function
Access to a treatment centre with expertise to manage immune-mediated adverse
reactions of atezolizumab
EXCLUSIONS:
Patients must not have:
Relapsed on or within 6 months of completing adjuvant durvalumab or atezolizumab,
or
Prior use of first-line nivolumab and ipilimumab or pembrolizumab
CAUTION:
Active, known or suspected autoimmune disease
Myasthenia gravis or Guillain-Barré syndrome
Patients with long term immunosuppressive therapy or systemic corticosteroids
(requiring more than 10 mg predniSONE/day or equivalent)
TESTS:
Baseline: CBC & differential, platelets, creatinine, alkaline phosphatase, ALT, total
bilirubin, LDH, sodium, potassium, TSH, morning serum cortisol, chest x-ray
o C-reactive protein and albumin (optional, and results do not have to be
BC Cancer Protocol Summary LUAVATZ Page 1 of 3
Activated: 1 Nov 2019 Revised: 1 Aug 2023 (Eligibility and exclusions updated)
Warning: The information contained in these documents are a statement of consensus of BC Cancer professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to
apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. Use of these documents is at
your own risk and is subject to BC Cancer's terms of use available at www.bccancer.bc.ca/terms-of-use
available to proceed with first treatment)
Before each treatment: CBC & differential, platelets, creatinine, alkaline phosphatase,
ALT, total bilirubin, LDH, sodium, potassium, calcium, TSH
If clinically indicated: chest x-ray, morning serum cortisol, lipase, glucose, serum or
urine HCG (required for women of child bearing potential if pregnancy suspected),
free T3 and free T4, serum ACTH levels, testosterone, estradiol, FSH, LH, ECG
Weekly telephone nursing assessment for signs and symptoms of side effects while
on treatment (optional)
PREMEDICATIONS:
Antiemetics are not usually required
Antiemetic protocol for low emetogenicity (see SCNAUSEA)
If prior infusion reactions to atezolizumab: diphenhydrAMINE 50 mg PO,
acetaminophen 325 to 975 mg PO, and hydrocortisone 25 mg IV 30 minutes prior to
treatment
TREATMENT:
Drug Dose BC Cancer Administration Guideline
atezolizumab 1200 mg IV in 250 mL NS over 1 hour*
* subsequent infusions may be given over 30 minutes if the first infusion is well-tolerated
Repeat every 3 weeks until disease progression or unacceptable toxicity
DOSE MODIFICATIONS:
No specific dose modifications. Toxicity managed by treatment delay and other
measures (see SCIMMUNE for management of immune-mediated adverse reactions to
checkpoint inhibitor immunotherapy, http://www.bccancer.bc.ca/chemotherapy-
protocols-site/Documents/Supportive%20Care/SCIMMUNE_Protocol.pdf).
PRECAUTIONS:
1. Serious immune-mediated reactions: can be severe to fatal and usually occur
during the treatment course, but may develop months after discontinuation of
therapy. May include enterocolitis, intestinal perforation or hemorrhage, hepatitis,
dermatitis, neuropathy, endocrinopathy, pneumonitis, as well as toxicities in other
organ systems. Early diagnosis and appropriate management are essential to
minimize life-threatening complications (see SCIMMUNE for management of
immune-mediated adverse reactions to checkpoint inhibitor immunotherapy,
BC Cancer Protocol Summary LUAVATZ Page 2 of 3
Activated: 1 Nov 2019 Revised: 1 Aug 2023 (Eligibility and exclusions updated)
Warning: The information contained in these documents are a statement of consensus of BC Cancer professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to
apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. Use of these documents is at
your own risk and is subject to BC Cancer's terms of use available at www.bccancer.bc.ca/terms-of-use
http://www.bccancer.bc.ca/chemotherapy-protocols-
site/Documents/Supportive%20Care/SCIMMUNE_Protocol.pdf).
2. Infusion-related reactions: isolated cases of severe infusion reactions have been
reported. Discontinue atezolizumab for severe reactions (Grade 3 or 4). Patients
with mild or moderate infusion reactions may receive atezolizumab with close
monitoring and use of premedication.
3. Infections: severe infections have been reported. Treat with antibiotics for
suspected or confirmed bacterial infections. Hold atezolizumab for Grade 3 or 4
infections. Permanently discontinue for any grade of meningitis or encephalitis.
Contact Dr. Barb Melosky or tumour group delegate at (604) 877-6000 or 1-800-
663-3333 with any problems or questions regarding this treatment program.
REFERENCES:
1. Genentech Inc. TECENTRIQ® full prescribing information. South San Francisco, CA, USA; August
2019.
2. Rittmeyer A, Barlesi F, Waterkamp D, et al. Atezolizumab versus docetaxel in patients with
previously treated non-small cell lung cancer (OAK): a phase 3, open-label, multicenter randomized
controlled trial. Lancet 2017; 389(10066):255-265.
3. Weber JS, et al. Management of adverse events following treatment with anti-programmed death-1
agents. Oncologist 2016;21:1-11.
BC Cancer Protocol Summary LUAVATZ Page 3 of 3
Activated: 1 Nov 2019 Revised: 1 Aug 2023 (Eligibility and exclusions updated)
Warning: The information contained in these documents are a statement of consensus of BC Cancer professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to
apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. Use of these documents is at
your own risk and is subject to BC Cancer's terms of use available at www.bccancer.bc.ca/terms-of-use
