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Non small cell lung cancer adjuvant atezolizumab

Treatment must be initiated and supervised by specialist physicians experienced in the treatment of cancer using immunological agents. Before commencing immunotherapy treatment in any patient, clinicians should have an understanding of the immune-related adverse events (irAEs) associated with immunotherapy treatment and their management.

Check for clinical trials in this patient group. Link to Australian Clinical Trials opens in a new tab or window website

Link to Clinical practice guidelines for the treatment of lung cancer opens in a new tab or window

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Cycle 1 and further cycles

Drug Dose Route Day
Atezolizumab 1,200 mg * IV infusion 1

In the IMpower010 trial, adjuvant atezolizumab started 3–8 weeks after the last dose of adjuvant chemotherapy.r

* Alternative atezolizumab intravenous dosing schedule 1,680 mg every 28 days.r Atezolizumab can be administered subcutaneously 1,875 mg every 21 days.r For more information see protocol ID 4473 Non small cell lung cancer adjuvant atezolizumab subcutaneous.

Frequency:
21 days 
Cycles:
Up to 12 months of treatment or until disease progression or unacceptable toxicity whichever comes first
Notes:

In the first few months after the start of immunotherapy, some patients can experience transient tumour flare (termed "pseudo progression" or an immune response). This may manifest as growth of existing lesions or the development of new lesions prior to later tumour regression. While this is rare (~5%), continuing treatment and performing a second scan 4 to 6 weeks later to confirm progression may be considered, particularly if the patient remains well.

Radiation recall has been observed with PD-L1 inhibitors, consideration should be given to the timing when starting this treatment after a prolonged course of radiation therapy.

Drug status:

Atezolizumab is PBS authority  opens in a new tab or window

Cost:
~ $6,840 per cycle "How this cost is calculated"

The cost displayed on the protocol is intended as rudimentary guide only for the Australian context.

The cost includes anti-cancer drugs only (not antiemetics, supportive medications or consumables), unless otherwise indicated.

Drug unit costs are taken directly from the Pharmaceutical Benefits Scheme (PBS) website (www.pbs.gov.au). These costs are reviewed and updated on eviQ at 6 monthly intervals. Anti-cancer drugs that are not included on the PBS do not have a cost included in eviQ protocols.

Where there are differing unit costs based on vial sizes and tablet strengths, the mean unit cost is used. The cost of oral continuous therapy is based on a 28 day month.

Where oral drugs are available on the PBS for both 30- and 60-day prescriptions, the unit cost for the 30-day supply is used.

The protocol cost is derived from drug dose calculations based upon a default body surface area (BSA) of 1.8 m2; weight of 75 kg; and creatinine clearance of 75 mL/min.

One off loading doses and ongoing maintenance doses are not included in protocol cost calculations.

The cost displayed is the actual drug cost and does not necessarily reflect the cost incurred by the patient as many anti-cancer drugs are reimbursed on the PBS.

The supportive therapies (e.g. antiemetics, premedications, growth factor support etc.), infusion times, diluents, volumes and routes of administration, if included, are listed as defaults. They may vary between institutions and can be substituted to reflect individual institutional policy.

Antiemetics if included in the treatment schedule are based upon recommendations from national and international guidelines. These are defaults only and may be substituted to reflect individual institutional policy. Select here for recommended doses of alternative antiemetics.

Cycle 1 and further cycles

Day 1
Atezolizumab 1,200 mg (IV infusion) in 250 mL sodium chloride 0.9% over 60 minutes

; if first dose is well tolerated, subsequent doses may be administered over 30 minutes

In the IMpower010 trial, adjuvant atezolizumab started 3–8 weeks after the last dose of adjuvant chemotherapy.r

Alternative atezolizumab intravenous dosing schedule 1,680 mg every 28 days.r Atezolizumab can be administered subcutaneously 1,875 mg every 21 days.r For more information see protocol ID 4473 Non small cell lung cancer adjuvant atezolizumab subcutaneous.

Frequency:
21 days 
Cycles:
Up to 12 months of treatment or until disease progression or unacceptable toxicity whichever comes first

Cycle 1 and further cycles

Drug Dose Route Day
Atezolizumab 1,200 mg * IV infusion 1

In the IMpower010 trial, adjuvant atezolizumab started 3–8 weeks after the last dose of adjuvant chemotherapy.r

* Alternative atezolizumab intravenous dosing schedule 1,680 mg every 28 days.r Atezolizumab can be administered subcutaneously 1,875 mg every 21 days.r For more information see protocol ID 4473 Non small cell lung cancer adjuvant atezolizumab subcutaneous.

Frequency:
21 days 
Cycles:
Up to 12 months of treatment or until disease progression or unacceptable toxicity whichever comes first
Notes:

In the first few months after the start of immunotherapy, some patients can experience transient tumour flare (termed "pseudo progression" or an immune response). This may manifest as growth of existing lesions or the development of new lesions prior to later tumour regression. While this is rare (~5%), continuing treatment and performing a second scan 4 to 6 weeks later to confirm progression may be considered, particularly if the patient remains well.

Radiation recall has been observed with PD-L1 inhibitors, consideration should be given to the timing when starting this treatment after a prolonged course of radiation therapy.

Drug status:

Atezolizumab is PBS authority  opens in a new tab or window

Cost:
~ $6,840 per cycle "How this cost is calculated"

The cost displayed on the protocol is intended as rudimentary guide only for the Australian context.

The cost includes anti-cancer drugs only (not antiemetics, supportive medications or consumables), unless otherwise indicated.

Drug unit costs are taken directly from the Pharmaceutical Benefits Scheme (PBS) website (www.pbs.gov.au). These costs are reviewed and updated on eviQ at 6 monthly intervals. Anti-cancer drugs that are not included on the PBS do not have a cost included in eviQ protocols.

Where there are differing unit costs based on vial sizes and tablet strengths, the mean unit cost is used. The cost of oral continuous therapy is based on a 28 day month.

Where oral drugs are available on the PBS for both 30- and 60-day prescriptions, the unit cost for the 30-day supply is used.

The protocol cost is derived from drug dose calculations based upon a default body surface area (BSA) of 1.8 m2; weight of 75 kg; and creatinine clearance of 75 mL/min.

One off loading doses and ongoing maintenance doses are not included in protocol cost calculations.

The cost displayed is the actual drug cost and does not necessarily reflect the cost incurred by the patient as many anti-cancer drugs are reimbursed on the PBS.

The supportive therapies (e.g. antiemetics, premedications, growth factor support etc.), infusion times, diluents, volumes and routes of administration, if included, are listed as defaults. They may vary between institutions and can be substituted to reflect individual institutional policy.

Antiemetics if included in the treatment schedule are based upon recommendations from national and international guidelines. These are defaults only and may be substituted to reflect individual institutional policy. Select here for recommended doses of alternative antiemetics.

Cycle 1 and further cycles

Day 1
Atezolizumab 1,200 mg (IV infusion) in 250 mL sodium chloride 0.9% over 60 minutes

; if first dose is well tolerated, subsequent doses may be administered over 30 minutes

In the IMpower010 trial, adjuvant atezolizumab started 3–8 weeks after the last dose of adjuvant chemotherapy.r

Alternative atezolizumab intravenous dosing schedule 1,680 mg every 28 days.r Atezolizumab can be administered subcutaneously 1,875 mg every 21 days.r For more information see protocol ID 4473 Non small cell lung cancer adjuvant atezolizumab subcutaneous.

Frequency:
21 days 
Cycles:
Up to 12 months of treatment or until disease progression or unacceptable toxicity whichever comes first

Indications:

  • Adjuvant treatment of completely resected stage II to IIIA non small cell lung cancer (NSCLC) after at least 1 (up to 4) cycles of cisplatin-based doublet adjuvant chemotherapy in patients with tumour PD-L1 expression ≥50%, without EGFR or ALK genomic tumour aberrations
    • ECOG performance status score 0 or 1.

Precautions:

If any of these conditions are present, clinical judgement should be used and individual cases discussed with an expert in the field as indicated:

  • significant autoimmune disease (e.g. myasthenia gravis, inflammatory bowel disease, systemic lupus erythematosus, rheumatoid arthritis, autoimmune ocular disease)
  • organ transplantation
  • previous history of viral hepatitis
  • HIV/acquired immune deficiency syndrome (AIDS)
  • previous radiation to the lungs.
Venous access required

IV cannula (IVC) or central venous access device (CVAD) is required to administer this treatment.

Read more about central venous access device line selection
Emetogenicity MINIMAL

No antiemetics should be routinely administered before treatment in patients without a history of nausea and vomiting. If patients experience nausea and/or vomiting, consider using the low antiemetic prophylaxis regimen.

Read more about preventing anti-cancer therapy induced nausea and vomiting
Immune-related adverse events (irAEs)

Immune-related adverse events (irAEs) can occur early and escalate quickly in patients receiving immune checkpoint inhibitors. irAEs can also occur after discontinuation of treatment. Fatalities have been reported. Management of irAEs is largely based on expert opinion and consensus guidelines.

Examples of irAEs with high risk of mortality include:

  • cardiac toxicity: myocarditis
  • musculoskeletal toxicity: myositis
  • neurological toxicity: encephalitis, Guillain-Barré syndrome, myelitis, myasthenia gravis
  • pulmonary toxicity: pneumonitis
  • skin toxicity: Stevens-Johnson syndrome, toxic epidermal necrolysis.

Examples of irAEs in order of frequency include:

  • Common
    • endocrinopathies: thyroid dysfunction
    • gastrointestinal toxicity: diarrhoea
    • musculoskeletal toxicity: arthralgia, myalgia
    • skin toxicity: rash, erythema, pruritus
  • Less common
    • endocrinopathies: hypophysitis, type I diabetes mellitus
    • gastrointestinal toxicity: colitis
    • musculoskeletal toxicity: inflammatory arthritis
    • ocular toxicity: dry eye
    • renal toxicity
    • skin toxicity: vitiligo
  • Rare
    • endocrinopathies: primary adrenal insufficiency
    • gastrointestinal toxicity: pancreatitis
    • haematological toxicity
    • musculoskeletal toxicity: vasculitis
    • ocular toxicity: uveitis, iritis.

Proactive monitoring, patient self-monitoring and early reporting of adverse events is critical. Treatment interruptions/discontinuation, consultation with specialist and administration of corticosteroids and/or supportive care is required to minimise the risk of death.

Read more about the management of immune-related adverse events (irAEs)
Baseline investigations

Consider ECG and troponin at baseline. There is no clear evidence regarding the efficacy/value of baseline ECG or troponin in patients receiving immune checkpoint inhibitor therapy. Some cancer specialists obtain baseline testing, and others continue this through the initial period of therapy. Consider urinalysis at baseline, particularly in patients with additional risk factors for developing immune-related acute kidney injury.
Blood tests

FBC, EUC, eGFR, LFTs, serum cortisol, TFTs and BSL at baseline.

Repeat FBC, EUC, eGFR, LFTs and BSL prior to each cycle. Check TFTs every 4-6 weeks during treatment and every 12 weeks as indicated after finalising treatment. Consider checking serum cortisol every 4-6 weeks during treatment and every 12 weeks as indicated after finalising treatment. Check lipase and amylase if symptomatic of pancreatitis.

In the absence of suspicion of immune-related adverse events less frequent monitoring may be applicable, according to institutional guidelines. Evidence for the frequency of routine blood testing with immunotherapies varies within published studies and guidelines.

Read more about immunotherapy blood test monitoring recommendations.
Hepatitis and HIV

Hepatitis screening is recommended in all patients who are to receive immune checkpoint inhibitors.

Immunotherapy is associated with inflammatory adverse reactions resulting from increased or excessive immune activity and patients are at risk of developing autoimmune hepatitis. It should be used with caution in patients who have a history of chronic hepatic infections (hepatitis B and C), detectable human immunodeficiency virus (HIV) viral load or acquired immune deficiency syndrome (AIDS).
Vaccinations

Live vaccines are not recommended for patients receiving this treatment. Caution is advised with inactivated vaccines, particularly the influenza vaccine.

For more information about vaccinations in people with cancer refer to the Australian Immunisation Handbook opens in a new tab or window.
Effects of cancer treatment on fertility

Studies to evaluate the effects of immune checkpoint inhibitor therapy on fertility have not been performed. Therefore, the effect on male and female fertility is unknown. Limited evidence supports that immune checkpoint inhibitor-related hypogonadism due to orchitis and hypophysitis can impact fertility. Immune checkpoint inhibitors can cause fetal harm when given to pregnant women. A pregnancy test should be considered in females of reproductive potential if sexually active. It is important that all patients of reproductive potential use effective contraception whilst on therapy and after treatment finishes. There is very limited evidence to provide guidance regarding contraception timelines. Some studies have demonstrated PD-1 receptor occupancy for greater than 9 months after anti-PD-1 therapy (Brahmer et al., 2010). As a result, some cancer specialists advise using contraception for at least six months or even as long as two years after treatment finishes.

Read more about the impact of cancer treatment on fertility opens in a new tab or window

Link to Brahmer et al., 2010 opens in a new tab or window
Evidence for dose modifications is limited, and the recommendations made on eviQ are intended as a guide only. They are generally conservative with an emphasis on safety. Any dose modification should be based on clinical judgement, and the individual patient’s situation including but not limited to treatment intent (curative vs palliative), the anti-cancer regimen (single versus combination therapy versus chemotherapy versus immunotherapy), biology of the cancer (site, size, mutations, metastases), other treatment related side effects, additional co-morbidities, performance status and patient preferences.Suggested dose modifications are based on clinical trial findings, product information, published guidelines and reference committee consensus . The dose reduction applies to each individual dose and not to the total number of days or duration of treatment cycle unless stated otherwise. Non-haematological gradings are based on Common Terminology Criteria for Adverse Events (CTCAE) opens in a new tab or window unless otherwise specified. Renal and hepatic dose modifications have been standardised where possible. For more information see dosing considerations & disclaimer.

Immune checkpoint inhibitor dose modifications 

  • Dose reduction is not recommended
  • No dose adjustment is required in the elderly or mild hepatic impairment. Immune checkpoint inhibitors have not been studied in patients with moderate to severe hepatic impairment.

Management of immune-related adverse events (irAEs)

Link to Management of immune-related adverse events (irAEs)

Kidney dosing recommendations 
No dose modification necessary

The drug interactions shown below are not an exhaustive list. For a more comprehensive list and for detailed information on specific drug interactions and clinical management, please refer to the specific drug product information and the following key resources: 

For more information see References & Disclaimer.

Atezolizumab
No formal pharmacokinetic drug interaction studies have been conducted with atezolizumab.
  Interaction Clinical management
Immunosuppressants (inc. corticosteroids) Reduced efficacy of both immunosuppressants and atezolizumab possible due to pharmacodynamic interaction

It is recommended that patients requiring corticosteroids prior to treatment receive the lowest possible dose (preferably no greater than 10 mg prednisolone or equivalent steroid per day). Once started on atezolizumab the use of corticosteroids to treat immune related adverse events (irAEs) does not appear to impact the clinical response to atezolizumab. In patients requiring ongoing corticosteroids post management of an irAE, the dose should be as low as possible.

Monitor for signs of organ rejection in transplant recipients.

eviQ provides safe and effective instructions on how to administer cancer treatments. However, eviQ does not provide every treatment delivery option, and is unable to provide a comprehensive list of cancer treatment agents and their required IV line giving set/filter or address chemical compatibilities related to IV drug preparation and administration. There may be alternative methods of treatment administration, and alternative supportive treatments that are also appropriate. Please refer to the individual product information monographs via the TGA opens in a new tab or window and Australian Injectable Drugs Handbook opens in a new tab or window websites for further information.

eviQ is currently updating the way information is presented in the administration section, if you notice any discrepancies please let us know, via feedback@eviq.org.au.

Day 1

Approximate treatment time: 90 minutes (initial); 60 minutes (subsequent)

Pre treatment assessment

Check for adverse events during previous treatment.

Any toxicity may require delay or omission of treatment and review by medical officer before commencing treatment.

Immunotherapy patient assessment tool prior to each treatment.

Prior to administration

Prime IV line(s).

Insert IV cannula or access TIVAD or CVAD.

Pre treatment medication

Verify premedication and antiemetics taken or administer as prescribed, if required.

Atezolizumab

Administer atezolizumab:
  • via IV infusion over 60 minutes for first infusion
  • if first infusion is tolerated, subsequent infusions may be administered over 30 minutes
  • observe for infusion-related reactions
  • flush with 50 mL of sodium chloride 0.9%.
Infusion-related reaction (IRR)

Stop infusion at first sign of anaphylaxis or severe IRR and manage as per emergency.

Grade 1 or 2:
  • consider holding or decreasing the rate of infusion, alert medical officer and monitor closely 
  • administer symptomatic medications as prescribed
  • further doses require close monitoring, premedications should be considered and prescribed by the medical officer as per local policy.
Grade 3 or 4: 
  • stop infusion immediately 
  • medical officer review
  • atezolizumab should be permanently discontinued. 

Post administration

Remove IV cannula and/or deaccess TIVAD or CVAD. 

Continue safe handling precautions (reproductive risk only) for 7 days after completion of drug(s).

Discharge

Patient information

Ensure patient receives protocol patient information sheet.

The side effects listed below are not a complete list of all possible side effects for this treatment. Side effects are categorised into the approximate onset of presentation and should only be used as a guide.

The most common side effects with this treatment are immune-related adverse events (irAEs). irAEs can escalate quickly and close monitoring of the patient is required. Symptoms should improve promptly after the introduction of immunosuppressive therapy. If this does not occur review the diagnosis and seek further specialist advice. Refer to the Management of immune related adverse events document for further information.

Immune related adverse events
Cardiotoxicity

Cardiotoxicity is a rare but serious side effect, which may manifest as asymptomatic reduction in left ventricular ejection fraction (LVEF), arrhythmia, cardiomyopathy, myocarditis, pericarditis, cardiac fibrosis, hypertension, cardiac ischaemia, congestive heart failure (CHF) and cardiac arrest.

Read more about Management of immune related adverse events.
Gastrointestinal toxicity

Colitis, diarrhoea or more bowel movements than usual; blood or mucous in stools; dark, tarry, sticky stools; abdominal pain or tenderness.

Upper gastrointestinal tract inflammation including gastritis, duodenitis and oesophagitis can occur less commonly. Symptoms include nausea, vomiting, dysphagia, odynophagia, haematemesis and abdominal pain.

Read more about Management of immune related adverse events
Haematological toxicity

Autoimmune haemolytic anaemia (AIHA), acquired thrombotic thrombocytopenic purpura (TTP), aplastic anaemia (AA), immune thrombocytopenia (ITP), acquired haemophilia (AH), haemolytic uremic syndrome (HUS) and lymphopenia are rare but potentially serious immune-related adverse events associated with immunotherapy treatment.

Read more about Management of immune related adverse events.
Hepatotoxicity

Transaminase and total bilirubin elevation, jaundice, severe nausea or vomiting, pain on the right side of the abdomen, drowsiness, dark urine, bleeding or bruising more easily than normal, anorexia.

Read more about Management of immune related adverse events.
Musculoskeletal toxicity

Inflammatory arthritis, temporal arteritis, arthralgia, myalgia, synovitis, vasculitis, polymyalgia-like syndrome and myositis.

Read more about Management of immune related adverse events.
Neurological toxicity

Aseptic meningitis, myasthenia gravis, Guillain-Barre syndrome, encephalitis, meningeal symptoms, optic neuritis, neuropathy and acute inflammatory demyelinating polyneuropathy are infrequent but potentially serious immune-related adverse events associated with immunotherapy treatment.

Read more about Management of immune related adverse events.
Ocular toxicity

Eye pain, blurred vision, Uveitis/iritis, episcleritis, blepharitis, optic neuritis, tear duct stenosis, conjunctivitis, hyperlacrimation, watery or dry eyes and photophobia. 

Read more about Management of immune related adverse events.
Other endocrinopathies

Type 1 diabetes mellitus, hypophysitis, hypopituitarism and adrenal insufficiency are infrequent but potentially serious immune-related adverse events associated with immunotherapy treatment.

Read more about Management of immune related adverse events
Pulmonary toxicity

Radiographic changes, dyspnoea, new or worsening cough, hypoxia, tachycardia, chest pain or fever.

Read more about Management of immune related adverse events.
Renal toxicity

Increase in serum creatinine, oliguria, haematuria, peripheral oedema and anorexia.

Read more about Management of immune related adverse events.
Skin toxicity

Rash including full thickness, pruritus, skin blisters, ulceration and necrosis. Radiation recall can occur at site of previous radiation therapy. Symptoms include vesiculation, desquamation and ulceration of the skin.

Read more about Management of immune related adverse events
Thyroid toxicity

Thyroid toxicity is common with immune checkpoint inhibitors. Hypothyroidism is most frequent however hyperthyroidism can also occur.

Read more about Management of immune related adverse events

Non-immune related adverse events
Headache
Nausea and vomiting

Read more about prevention of treatment induced nausea and vomiting
Fatigue

Read more about fatigue
Fever
Anorexia

Loss of appetite accompanied by decreased food intake.

Read more about anorexia

The evidence supporting this protocol is provided by a phase III multicentre, international, randomised, open-label trial (IMpower 010) involving 1280 patients comparing adjuvant atezolizumab with best supportive care (BSC) in patients with completely resected stage IB-IIIA NSCLC who received at least 1 cycle (up to 4 cycles) of investigator’s choice of cisplatin-based doublet chemotherapy (cisplatin plus either vinorelbine, gemcitabine or docetaxel; or plus pemetrexed for patients with non-squamous NSCLC).r

Between October 2015 and September 2018, 507 patients were randomised to receive atezolizumab (1200 mg every 3 weeks for 16 cycles or 1 year) and 498 patients were randomised to receive BSC.

The primary end point was investigator-assessed disease-free survival (DFS) tested hierarchically in 3 pre-specified populations:

  • stage II-IIIA with PD-L1 expression of ≥1%
  • all patients in the stage II-IIIA population
  • intention-to-treat (ITT) population (stage IB-IIIA).

Secondary end points were overall survival (OS) in the ITT population, DFS in the stage II-IIIA population with PD-L1 ≥50%, and the 3-year and 5-year DFS in all 3 populations.

Efficacy

At the interim analysis after a median follow up of 32.2 months in the stage II–IIIA population, atezolizumab improved DFS compared with BSC with a stratified hazard ratio (HR) of 0.66 (95% CI 0.50-0.88, p=0.0039) in PD-L1 ≥1% population and 0.79 (95% CI, 0.64-0.96, p=0.020) in all stage II-IIIA population. DFS benefit for atezolizumab was not statistically significant in the ITT population (HR=0.81; 95% CI 0.67-0.99, p=0.040).r

The 3-year DFS in the stage II-IIIA with PD-L1 expression ≥1%, all stage II-IIIA, and ITT populations for atezolizumab were 60%, 56%, and 58% vs 48%, 49% and 53% for BSC, respectively.r

In the stage II-IIIA with PD-L1 ≥50% population, atezolizumab improved DFS compared to BSC (unstratified HR=0.43, 95% CI, 0.27-0.68). However, for patients with PD-L1 1-49% and PD-L1 <1% in this population, atezolizumab did not show a benefit as DFS was similar in both groups (unstratified HR=0.87, 95% CI, 0.60-1.26 and unstratified HR=0.97, 95% CI, 0.72-1.31; respectively).r

Atezolizumab did not show a DFS benefit in the EGFR and ALK-positive subgroups.r

At subsequent analysis in April 2022, with a median follow up of 45.3 months in the ITT population, OS data remains immature. While OS cannot be formally tested in the ITT population, exploratory analysis showed an OS improvement in favour of atezolizumab vs BSC in the stage II-IIIA PD-L1 ≥1% population [stratified HR 0.71 (95% CI, 0.49-1.03)]. While not powered for subgroup analysis, the OS benefit for atezolizumab vs BSC was strongest in the stage II-IIA PD-L1 >50% population [unstratified HR 0.43 (95% CI, 0.24-0.78)] which remains when patients with known ALK/EGFR alterations were excluded. No OS improvement was seen in ITT, stage II-IIIA populations or in the stage II-IIIA PD-L1 <1% population. Overall, the data appears to reflect the DFS data.r

Quality of life data was not collected.

Kaplan-Meier curve of OS in stage II-IIIA PD-L1 >50% (excluding patients with known EGFR/ALK alterations)r

©Annal Oncol 2023

5 year follow up data (presented in poster form) shows similar results, with median OS remaining immature in the ITT group, as seen in the below table.r

5 year follow up data (abstract)r

©J Clin Oncol 2024

Toxicity

Grade 3/4 adverse events occurred in 22% of patients receiving atezolizumab and 11.5% of patients receiving BSC. Treatment-related adverse events occurred in 68% of patients in atezolizumab group (11% with grade 3/4 and 1% with grade 5 severity). Treatment-related adverse events led to atezolizumab discontinuation in 18% of patients, most frequently due to pneumonitis, hypothyroidism and increased aspartate aminotransferase (1% each).r

Summary of adverse eventsr

© Lancet 2021

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Version 3

Date Summary of changes
25/11/2024 

Protocol reviewed at the Respiratory Reference Committee Meeting on 18/10/2024. Following changes made:

  • ID 4473 Non small cell lung cancer adjuvant atezolizumab subcutaneous added as a related page
  • Treatment schedule - link to additional dosing instructions for atezolizumab subcutaneous added to treatment schedule.
  • Side effects - flu-like symptoms removed, headache added.
  • Evidence - updated with 5 year follow up data.

Version increased to V.3. Next review in 2 years.

Version 2

Date Summary of changes
08/02/2024

Protocol updated with ADDIKD guideline recommendations.

PDF of previous protocol.

Version number changed to V.2.
03/04/2024 Patient information side effects preamble updated to include examples of 'common, less common and rare' side effects following consensus at the immunotherapy and skin reference committee meeting held on 23rd of February 2024. 

Version 1

Date Summary of changes
19/05/2023 New protocol taken to Medical Oncology Reference Committee meeting.
03/07/2023 Protocol approved and published. Review 1 year.

The information contained in this protocol is based on the highest level of available evidence and consensus of the eviQ reference committee regarding their views of currently accepted approaches to treatment. Any clinician (medical oncologist, haematologist, radiation oncologist, medical physicist, radiation therapist, pharmacist or nurse) seeking to apply or consult this protocol is expected to use independent clinical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. While eviQ endeavours to link to reliable sources that provide accurate information, eviQ and the Cancer Institute NSW do not endorse or accept responsibility for the accuracy, currency, reliability or correctness of the content of linked external information sources. Use is subject to eviQ’s disclaimer available at www.eviQ.org.au

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The currency of this information is guaranteed only up until the date of printing, for any updates please check:

https://www.eviq.org.au/p/4291

08 Jun 2025