No dose reduction for TECENTRIQ is recommended. In general, withhold TECENTRIQ for severe (grade 3) immune-mediated ARs. Permanently discontinue TECENTRIQ for life-threatening (grade 4) immune-mediated ARs, recurrent severe (grade 3) immune-mediated reactions that require systemic immunosuppressive treatment, or an inability to reduce corticosteroid dose to 10 mg or less of prednisone or equivalent per day within 12 weeks of initiating steroids.
In general, if TECENTRIQ requires interruption or discontinuation, administer systemic corticosteroid therapy (1 to 2 mg/kg/day prednisone or equivalent) until improvement to grade 1 or less. Upon improvement to grade 1 or less, initiate corticosteroid taper and continue to taper over at least 1 month. Consider administration of other systemic immunosuppressants in patients whose immune-mediated ARs are not controlled with corticosteroid therapy.
Any ARs that require management different from the general guidelines above are summarized in the following tabs. For more information, please refer to the TECENTRIQ Prescribing Information.
Patient symptoms may include
When adverse reaction recovers to grade 1 or is resolved and corticosteroid dose is less than or equal to prednisone 10 mg per day (or equivalent)
If no complete or partial resolution within 12 weeks of initiating steroids or inability to reduce prednisone to 10 mg per day or less (or equivalent) within 12 weeks of initiating steroids
Patient symptoms may include
When adverse reaction recovers to grade 1 or is resolved and corticosteroid dose is less than or equal to prednisone 10 mg per day (or equivalent)
If no complete or partial resolution within 12 weeks of initiating steroids or inability to reduce prednisone to 10 mg per day or less (or equivalent) within 12 weeks of initiating steroids
Patient symptoms may include
When adverse reaction recovers to grade 1 or is resolved and corticosteroid dose is less than or equal to prednisone 10 mg per day (or equivalent)
If no complete or partial resolution within 12 weeks of initiating steroids or inability to reduce prednisone to 10 mg per day or less (or equivalent) within 12 weeks of initiating steroids
Patient symptoms may include
When adverse reaction recovers to grade 1 or is resolved and corticosteroid dose is less than or equal to prednisone 10 mg per day (or equivalent)
If no complete or partial resolution within 12 weeks of initiating steroids or inability to reduce prednisone to 10 mg per day or less (or equivalent) within 12 weeks of initiating steroids
When adverse reaction recovers to grade 1 or is resolved and corticosteroid dose is less than or equal to prednisone 10 mg per day (or equivalent)
If no complete or partial resolution within 12 weeks of initiating steroids or inability to reduce prednisone to 10 mg per day or less (or equivalent) within 12 weeks of initiating steroids
Patient symptoms may include
When clinically stable
Patient symptoms may include
When adverse reaction recovers to grade 1 or is resolved and corticosteroid dose is less than or equal to prednisone 10 mg per day (or equivalent)
If no complete or partial resolution within 12 weeks of initiating steroids or inability to reduce prednisone to 10 mg per day or less (or equivalent) within 12 weeks of initiating steroids
Patient symptoms may include
Topical emollients and/or topical corticosteroids may be adequate to treat mild to moderate non-exfoliative rashes.
Patient symptoms may include
When adverse reaction recovers to grade 1 or is resolved and corticosteroid dose is less than or equal to prednisone 10 mg per day (or equivalent)
If no complete or partial resolution within 12 weeks of initiating steroids or inability to reduce prednisone to 10 mg per day or less (or equivalent) within 12 weeks of initiating steroids
Patient symptoms may include
ALT=alanine aminotransferase; AR=adverse reaction; AST=aspartate aminotransferase; carbo/etop=carboplatin/etoposide; DRESS=drug rash with eosinophilia and systemic symptoms; HCC=hepatocellular carcinoma; SJS=Stevens-Johnson syndrome; TEN=toxic epidermal necrolysis; ULN=upper limit of normal.
*If AST and ALT are less than or equal to ULN at baseline, withhold or permanently discontinue TECENTRIQ based on recommendations for hepatitis with no liver involvement. For patients with HCC, please see the Adverse Reaction Profile.
TECENTRIQ Prescribing Information. Genentech, Inc.
TECENTRIQ Prescribing Information. Genentech, Inc.
Data on file. Genentech, Inc.
Data on file. Genentech, Inc.
FDA approves atezolizumab for extensive-stage small cell lung cancer [press release]. U.S. Food and Drug Administration; March 18, 2019.
FDA approves atezolizumab for extensive-stage small cell lung cancer [press release]. U.S. Food and Drug Administration; March 18, 2019.
Horn L, Mansfield AS, Szczȩsna A, et al; IMpower133 Study Group. First-line atezolizumab plus chemotherapy in extensive-stage small-cell lung cancer. N Engl J Med. 2018;379:2220-2229.
Horn L, Mansfield AS, Szczȩsna A, et al; IMpower133 Study Group. First-line atezolizumab plus chemotherapy in extensive-stage small-cell lung cancer. N Engl J Med. 2018;379:2220-2229.
Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Small Cell Lung Cancer V.3.2023. © National Comprehensive Cancer Network, Inc. 2022. All rights reserved. Accessed December 21, 2022. To view the most recent and complete version of the guideline, go online to www.NCCN.org.
Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Small Cell Lung Cancer V.3.2023. © National Comprehensive Cancer Network, Inc. 2022. All rights reserved. Accessed December 21, 2022. To view the most recent and complete version of the guideline, go online to www.NCCN.org.
Sabari JK, Lok BH, Laird JH, Poirier JT, Rudin CM. Unravelling the biology of SCLC: implications for therapy. Nat Rev Clin Oncol. 2017;14:549-561.
Sabari JK, Lok BH, Laird JH, Poirier JT, Rudin CM. Unravelling the biology of SCLC: implications for therapy. Nat Rev Clin Oncol. 2017;14:549-561.
Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Small Cell Lung Cancer V.1.2019. © National Comprehensive Cancer Network, Inc. 2018. All rights reserved. Accessed October 10, 2018. To view the most recent and complete version of the guideline, go online to www.NCCN.org.
Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Small Cell Lung Cancer V.1.2019. © National Comprehensive Cancer Network, Inc. 2018. All rights reserved. Accessed October 10, 2018. To view the most recent and complete version of the guideline, go online to www.NCCN.org.
Byers LA, Rudin CM. Small cell lung cancer: where do we go from here? Cancer. 2015;121:664-672.
Byers LA, Rudin CM. Small cell lung cancer: where do we go from here? Cancer. 2015;121:664-672.
Liu S, Dziadziuszko R, Sugawara S, et al. Five-year survival in patients with ES-SCLC treated with atezolizumab in IMpower133: IMbrella A extension study results. Presented at: International Association for the Study of Lung Cancer 2023 World Conference on Lung Cancer; September 9-12, 2023; Singapore.
Liu S, Dziadziuszko R, Sugawara S, et al. Five-year survival in patients with ES-SCLC treated with atezolizumab in IMpower133: IMbrella A extension study results. Presented at: International Association for the Study of Lung Cancer 2023 World Conference on Lung Cancer; September 9-12, 2023; Singapore.
Data on file. Roche.
Data on file. Roche.
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