Carboplatin, Paclitaxel, Avastin and Tecentriq for Stage 4 Non-Small Cell Lung Cancer

Apr 06, 2021

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What is Carboplatin, Paclitaxel, Avastin and Tecentriq care plan, and how does it work?

It is a combination of chemotherapy and immunotherapy regimen used for certain types of stage 4 non-small cell lung cancer.

 Carboplatin and Paclitaxel are chemotherapy treatment, Avastin is a targeted therapy treatment and Tecentriq is an immunotherapy treatment

∙       Carboplatin is also called “Platinum-therapy” and kills cancer cells through binding with their DNA, preventing their production and inducing their death.

∙       Paclitaxel is “Taxane” class of chemotherapy medicine which kills cancer cells by damaging the structure or the “skeleton” that supports them, thus preventing their growth and division.

∙       Avastin is also called Bevacizumab. It is a “Monoclonal antibody” that binds and inhibits growth factors important for new blood vessels formation especially in cancer, thus inhibiting cancer cells

∙       Tecentriq also known as “Atezolizumab” is an immunotherapy works by binding to a specific area on immune cells called PD-L1 receptor, helping Immune system to attack and kill cancer cells.

Who gets this regimen:

This regimen is mainly given for non-squamous non-small cell lung cancer that is 

1.      advanced or stage 4, 

2.      cancer cells are free of EGFR and ALK mutations and 

3.      In combination with chemotherapy Tecentriq is given for lung cancers with or without PDL1 expression.

How is this regimen given?

∙       Going back to the main anti-cancer therapy regimen – carboplatin, Paclitaxel and Avastin and Tecentriq, these medications are given by vein on the same day, followed by a rest period of 21 days. 

∙       Each 21 days treatment is considered a cycle. 

∙       Usually 6 cycles are given for a total treatment period of average 18 weeks.

∙       After 4 to 6 cycles of all four drugs, a maintenance treatment consisting of Avastin and Tecentriq every 3 weeks is usually given to prevent disease progression.

What are side effects?

Different agents have specific side effects. It is also important to remember you may not have every side effect related to each medicine of the combination therapy.

You should call your doctor if have: 

•       Shortness of breath which is of new onset.

•       High fever > 100.4 F.

•       Excessive diarrhea of equal to or more than 7 loose stools per day despite taking anti-diarrheal medication prescribed by your doctor. 

•       Diarrhea that is accompanied by significantly reduced urine output, dizziness upon standing up and low blood pressure.  

•       Abdominal pain with nausea and vomiting, fatigue and deep yellow skin and urine. This may indicate liver toxicity.

    –     Swelling of legs associated with pain especially, if one sided. This may indicate blood clots that can be precipitated by Avastin

    –     Stroke like symptoms ( sudden onset of weakness/ numbness on one side of the body, sudden unexplained speech disturbance) may indicate TIA or Stroke. Rarely, this could be precipitated by Avastin. 

The most common side effects are:

•       Allergic reaction during or after chemotherapy infusion. Tecentriq also can cause skin rash and itching which are immune mediated. 

•       Tiredness and weakness

•       Reduced blood cells: resulting in fatigue, increased possibility of infections and bleeding.

•       Nausea

•       Constipation or diarrhea. Both chemotherapy and immunotherapy may cause diarrhea. 

•       Loss of appetite

   – Tingling, numbness or pain in hands/ feet/ legs which may indicate NEUROPATHY that can be cased by Paclitaxel. 

  – Increased Blood Pressure is a common side effect of Avastin. If you are monitoring your BP at home and  if it is unusually elevated compared to baseline, please call your doctor. Your doctor may use  blood pressure medications to control it. Controlling your blood pressure and maintaining it in a healthy range is crucial while on Avastin. 

– Increased Protein in the urine ( proteinuria) is a side effect of Avastin. Your doctor will monitor your urine samples for protein before you get Avastin. For this reason, you will be asked to give a urine sample prior to every treatment with Avastin. 

•       Hair loss

•       Cough

•       Infections 

•       Fever

Please note that Tecentriq is an immunotherapy that activates your immune system and may attack any of the organs. 

•       Other than these common side effects, Tecentriq may cause skin rashes, liver, kidney, lung and thyroid problems. 

•       Your doctor will monitor thyroid and liver tests while you are on treatment. It is important to follow your directions for lab tests.

Please call your doctor if you feel you are not well and if side effects don’t reduce or go away after medications prescribed your doctor.  

Please view the video “How to self-manage common symptoms before calling your doctor”:

Please tell your doctor about any medicines you are taking, including vitamins, herbal supplements and over-the-counter medicines, to make sure they won’t interfere with your treatment.

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. For managing a specific side effect.