Atezolizumab (Tecentriq) for the first-line treatment of advanced lung cancer

Introduction

Atezolizumab (trade name: Tecentriq) has been approved in Germany since September 2019 for the first-line treatment of the following types of cancer:

Advanced non-small-cell lung cancer:

Atezolizumab in combination with the medications

  • nab-paclitaxel and carboplatin, or
  • bevacizumab, carboplatin and paclitaxel

Advanced small-cell lung cancer:

Atezolizumab in combination with the medications carboplatin and etoposide.

Lung cancer is caused by malignant changes in the cells of the airways (). This kind of cancer is also called bronchogenic carcinoma. There are two main types of lung cancer:

  • Small-cell lung cancer (SCLC)
  • Non-small-cell lung cancer (NSCLC)

The cancer tumors are surgically removed, if possible. But sometimes a tumor has already become too large or it has spread to other parts of the body (metastasis) through the blood or lymphatic system. It is then called advanced lung cancer. At that point, a full recovery is often no longer possible. Treatment then aims to stop the cancer from getting worse for as long as possible and reduce the symptoms.

Doctors distinguish between two types of non-small-cell lung cancer: cancer in which at least 50% of the cells have PD-L1 (programmed death ligand 1) (PD-L1-positive tumor) and cancer in which fewer than 50% of the cells have PD-L1 (PD-L1-negative tumor). PD-L1 is a protein that prevents the from attacking the tumor.

Atezolizumab blocks the effect of the PD-L1 protein, reactivating the ability of the immune system to fight the cancer and stop it from growing so fast.

Application

Atezolizumab is given every three weeks at a dose of 1,200 mg as an infusion (IV drip) into a vein. Treatment is stopped if the disease progresses or if very severe side effects arise.

Other treatments

There are various treatment options for advanced non-small-cell lung cancer, depending on the changes in the tumor tissue:

  • In PD-L1-negative NSCLC, one possible treatment is cisplatin or carboplatin in combination with vinorelbine, gemcitabine, docetaxel, paclitaxel or pemetrexed. Another option is carboplatin in combination with nab-paclitaxel.
  • In PD-L1-positive NSCLC, the treatment is pembrolizumab.

Possible first-line treatments for advanced small-cell lung cancer include carboplatin or cisplatin combined with etoposide.

Assessment

In 2019, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) looked into whether atezolizumab has any advantages or disadvantages in the first-line treatment of advanced lung cancer when compared with the standard treatments.

There was enough suitable data for the following groups of people:

  • People with advanced non-small-cell lung cancer who have a PD-L1-negative tumor
  • People with advanced small-cell lung cancer

More information

This information summarizes the main results of reviews produced by the Institute for Quality and Efficiency in Health Care (IQWiG, Germany). The reviews were commissioned by the German Federal Joint Committee (G-BA) as part of the “early benefit assessment of medications.” On the basis of the reviews and the hearings received, the G-BA passed a resolution on the added benefit of atezolizumab (Tecentriq) for:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Atezolizumab (NSCLC, combination chemotherapy with paclitaxel) – Benefit assessment according to §35a Social Code Book V. Dossier assessment; Commission A19-83. December 20, 2019. (IQWiG reports; Volume 858).

Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Atezolizumab (NSCLC, combination chemotherapy with nab-paclitaxel) – Benefit assessment according to §35a Social Code Book V. Dossier assessment; Commission A19-84. December 20, 2019. (IQWiG reports; Volume 859).

Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Atezolizumab (non-small cell lung cancer) – Benefit assessment according to §35a Social Code Book V. Dossier assessment; Commission A19-86. January 13, 2020. (IQWiG reports; Volume 868).

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on January 30, 2020
Next planned update: 2023

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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