Treatment Name: ABCP (Atezolizumab (Tecentriq®) + Bevacizumab (Avastin®) + Carboplatin + Paclitaxel)
ABCP (Atezolizumab (Tecentriq®) + Bevacizumab (Avastin®) + Carboplatin + Paclitaxel) is a Treatment Regimen for Lung Cancer, Non-Small Cell Lung Cancer (NSCLC)
How does ABCP work?
Both carboplatin and paclitaxel are chemotherapy drugs designed to kill and slow the growth of cancer cells.
Bevacizumab is an immunotherapy drug designed to slow the growth of cancer cells by decreasing the spread of blood vessels carrying nutrients to cancer cells.
Atezolizumab is an immunotherapy drug designed to enhance your immune system’s ability to target and specifically kill lung cancer cells. Sometimes cancer cells have the ability to escape discovery from specific cancer-fighting cells known as T-cells. By attaching to lung cancer cells, atezolizumab helps your body’s T-cells recognize the cancer and kill it.
A – Atezolizumab (Tecentriq®)
B – Bevacizumab (Avastin®)
C – Carboplatin
P – Paclitaxel (Taxol®)
Goals of therapy:
ABCP is given as a first-line treatment to patients with metastatic NSCLC who do not have an EGFR or ALK mutation. ABCP is designed to kill or slow the growth of cancer cells. It may help relieve symptoms of NSCLC and slow the progression of lung cancer, but it is not commonly given with the goal of cure.
- Atezolizumab intravenous (I.V.) infusion over 60 minutes on Day 1
- If the first infusion is well tolerated, subsequent doses may be given over 30 minutes
- Bevacizumab I.V. infusion over 90 minutes on Day 1 of Cycle 1
- Then over 60 minutes for Cycle 2, if no infusion reactions occur
- Then over 30 minutes for Cycles 3 and on, if no infusion reactions occur
- Carboplatin I.V. infusion over 30 minutes on Day 1
- Paclitaxel I.V. infusion over 3 hours on Day 1
The induction phase of ABCP is repeated every 21 days. This is known as one Cycle. Each cycle may be repeated up to 4 to 6 times. Duration of therapy may last up to five months, depending upon response, tolerability, and number of cycles prescribed.
- Atezolizumab I.V. infusion over 30 minutes on Day 1
- The infusion may be given over 60 minutes for history of infusion reactions
- Bevacizumab I.V. infusion over 30 minutes on Day 1 of Cycle 1
- The infusion may be given over 60 or 90 minutes for history of infusion reactions
Atezolizumab and Bevacizumab may both be given during the maintenance phase or only one of them may be given.
The maintenance phase of ABCP is repeated every 21 days. This is known as one Cycle. Each cycle may be repeated until the treatment no longer works or until unacceptable side effects occur. Duration of therapy depends upon response, tolerability, and number of cycles prescribed.
Estimated total infusion time for this treatment:
- For induction treatment, infusion time may take up to 7 hours for Cycle 1, Day 1; Up to 6 hours for Cycle 2, Day 1; as short as 5 hours for the first day of Cycles 3 and on
- For maintenance treatment, infusion time may take up to 2 hours for Day 1 of each Cycle
- Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time
ABCP is usually given in an outpatient infusion center, allowing the person to go home afterwards. On occasion, it may be given in the hospital if someone is too sick for outpatient treatment.
Click here for the common ABCP starting doses.
In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported side effects of ABCP are shown here:
A note about side effect percentages
- Hair loss (47%)
- Tingling or numbness in fingers or toes (39%)
- Nausea (34%)
- Fatigue (26%)
- Anemia [low red blood cells] (24%)
- Decreased appetite (22%)
- Diarrhea (20%)
- High blood pressure (19%)
- Neutropenia [low white blood cells] (18%)
- Joint pain (17%)
- Constipation (17%)
- Weakness (15%)
- Nose bleed (14%)
- Muscle pain (14%)
- Thrombocytopenia [low platelets] (13%)
- Protein in urine (13%)
- Skin rash (13%)
- Mouth sores (12%)
- Tingling or burning sensation on skin (11%)
- Neutropenic fever (9%)
Approximately 33% of patients discontinue treatment due to unacceptable side effects at some point during therapy with ABCP.
Importantly, not all people who experience a side effect from ABCP (Atezolizumab + Bevacizumab + Carboplatin + Paclitaxel) will experience it in the same way. It may be mild in some or severe in others, depending upon the individual. Everybody is different. Additionally, side effects may vary over time. For some, side effects may be a reason to delay or switch treatment, reduce the dose, or avoid future treatment with a certain medication altogether.
Side effects may be treatable when they occur or preventable by taking certain medications before they happen. When medications are taken to prevent a problem, this is known as prophylaxis, or "prophy" for short.
After starting treatment with ABCP, be sure to come back and watch all of the side effect videos shown below. Each of these videos contain valuable information about side effect management that will hopefully help you to both feel better and stay out of the hospital.
How often is monitoring needed?
Labs (blood tests) may be checked before each treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), urine protein levels, thyroid function, blood amylase levels, blood lipase levels, plus any others your doctor may order.
How often is imaging needed?
Imaging may be checked before treatment and during cancer treatment if there are concerns for disease progression or side effects. Imaging may include: X-rays, magnetic resonance imaging (MRI), computerized tomography (CT) scans, or positron emission tomography (PET) scans.
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue ABCP as planned, reduce the dose of future treatments, delay the next dose until the side effect goes away, or switch to an alternative therapy.
- Because atezolizumab (Tecentriq®) enhances your immune system response to cancer, it may cause unintended side effects that are caused by the immune system and affect healthy cells as well. Some organs that can be affected include the thyroid, pituitary gland, adrenal glands, pancreas, gastrointestinal tract, liver, lungs, skin and eyes. A corticosteroid (e.g., prednisone) may be prescribed by your doctor to decrease symptoms if the immune system attacks healthy tissues during treatment
- Paclitaxel tends to cause infusion reactions that can be related to the cremophor that is used in the IV formulation. Patients may receive several medications prior to receiving paclitaxel (this is known as "pre-medication") to decrease the risk of infusion reactions. Common pre-medications given are a histamine-2 blockers such as famotidine (Pepcid®) or ranitidine (Zantac®), a histamine-1 blocker such as diphenhydramine (Benadryl®), and a corticosteroid such as dexamethasone
- Bevacizumab may lead to increases in blood pressure after starting therapy. If you currently are taking medications to control blood pressure, the doses of these medications may need to be adjusted or you may need to take additional medications to help control blood pressure
- Tell your doctor if you plan on having any surgeries while on therapy with bevacizumab as it can delay wound healing from the surgery and possibly lead to complications
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for NSCLC (Non-Small Cell Lung Cancer). Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for ABCP (Atezolizumab (Tecentriq®) + Bevacizumab (Avastin®) + Carboplatin + Paclitaxel), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for ABCP (Atezolizumab (Tecentriq®) + Bevacizumab (Avastin®) + Carboplatin + Paclitaxel). Depending upon your income, they may be able to help cover the cost of:
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as ABCP (Atezolizumab (Tecentriq®) + Bevacizumab (Avastin®) + Carboplatin + Paclitaxel) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.
What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.
Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.
Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.
Learn more about pursuing emotional wellness while receiving treatment with ABCP (Atezolizumab (Tecentriq®) + Bevacizumab (Avastin®) + Carboplatin + Paclitaxel)