Atezolizumab in combination for treating metastatic non-squamous non-small-cell lung cancer

Atezolizumab (Tecentriq, Roche) plus bevacizumab (Avastin, Roche), paclitaxel and carboplatin, is indicated 'for the first-line treatment of adult patients with metastatic non-squamous non-small cell lung cancer (NSCLC). In patients with epidermal growth factor receptor (EGFR)-mutant or anaplastic lymphoma kinase (ALK)-positive NSCLC, Tecentriq, in combination with bevacizumab, paclitaxel and carboplatin, is indicated only after failure of appropriate targeted therapies'.

Atezolizumab plus bevacizumab, paclitaxel and carboplatin has been available in the UK for treating metastatic non-squamous EGFR- or ALK-positive NSCLC after failure of appropriate targeted therapies through the early access to medicines scheme.

In the induction phase, the recommended dose of atezolizumab is 1,200 mg administered by intravenous infusion, followed by bevacizumab (15 mg/kg), paclitaxel (200 mg/m²)*, and then carboplatin (area under the curve 6) every 3 weeks for 4 or 6 cycles. The induction phase is followed by a maintenance phase without chemotherapy in which 1,200 mg atezolizumab followed by bevacizumab (15 mg/kg) is administered by intravenous infusion every 3 weeks.

* In the pivotal clinical trial (IMpower150), the paclitaxel starting dose for patients of Asian family origin was 175 mg/m² because of a higher overall level of haematological toxicities in these patients compared with those of non-Asian family origin.

It is recommended that patients have treatment with atezolizumab until loss of clinical benefit or unmanageable toxicity, and bevacizumab until disease progression or unacceptable toxicity, whichever occurs first. Dose reductions of atezolizumab are not recommended. Paclitaxel and carboplatin were administered in the IMpower150 trial until completion of 4 or 6 cycles, or progressive disease, or unacceptable toxicity, whichever occurs first.

Atezolizumab: £3,807.69 per 1,200‑mg vial (excluding VAT; British national formulary [BNF] online, accessed March 2019).

Bevacizumab: £242.66 per 100‑mg vial (excluding VAT; BNF online, accessed March 2019).

Costs of carboplatin and paclitaxel may vary in different settings because of negotiated procurement discounts.

The company has commercial arrangements. This makes atezolizumab and bevacizumab available to the NHS with a discount. The size of the discount is commercial in confidence. It is the company's responsibility to let relevant NHS organisations know details of the discount.