Published

May 11, 2025

Atezolizumab (in combination with bevacizumab, carboplatin and paclitaxel) [ATE5]

The treatment of adult patients with EGFR or ALK or ROS1 or MET exon 14 or KRAS G12C or RET or BRAF mutation positive locally advanced or metastatic non- squamous non-small cell lung cancer after failure of appropriate targeted therapy where the following criteria are met:

  1. This application is being made by and the first cycle of systemic anti -cancer therapy with the combination of atezolizumab, bevacizumab, carboplatin and paclitaxel will be prescribed by a consultant specialist specifically trained and accredited in the use of systemic anti-cancer therapy.
  2. The prescribing clinician is fully aware of the management of and the treatment modifications that may be required for immune-related adverse reactions due to anti-PD-L1 treatments including pneumonitis, colitis, nephritis, endocrinopathies, hepatitis and skin toxicities.
  3. The patient has a histologically- or cytologically-confirmed diagnosis of non-squamous non-small cell lung cancer (NSCLC).
  4. The patient has stage IIIB or IIIC or IV NSCLC or disease that recurred after potentially curative treatment with local management of NSCLC with surgery/chemoradiotherapy/radiotherapy.
  5. The patient’s lung cancer has shown an actionable mutation for which there is funded NHS England therapy and that the patient has been treated with such targeted therapy. Please mark which actionable mutation has been identified and for which the patient has been treated:
  • EGFR activating mutation except exon 20 insertion mutation or
  • EGFR exon 20 insertion mutation or
  • ALK gene rearrangement or
  • ROS1 gene rearrangement or
  • MET exon 14 skipping mutation or
  • KRAS G12C mutation or
  • RET gene fusion or
  • BRAF V600 mutation
  1. The patient has not received prior treatment with an anti PD-1, anti-PD-L1, anti-PD-L2, anti-CD137 or anti-cytotoxic T-lymphocyte-associated antigen-4 (CTL-4) antibody unless the patient discontinued or completed checkpoint inhibitor immunotherapy as part of adjuvant/neoadjuvant/maintenance therapy without disease progression and at least 6 months elapsed between the date of the last immunotherapy treatment and the date of first diagnosis of relapse with recurrent or metastatic disease. Note: NHS England does not commission re-treatment with checkpoint inhibitor therapy for patients who have discontinued or completed previous checkpoint inhibitor therapy for the locally advanced/metastatic indication. Please mark below if the patient received previous checkpoint inhibitor therapy and in which setting:
  • the patient has never received any immunotherapy for NSCLC. If so, please type ‘n/a’ in the ‘Time gap’ box below or
  • the patient has previously been treated with adjuvant immunotherapy for NSCLC and discontinued immunotherapy without disease progression and at least 6 months prior to the first diagnosis of relapse. Please document in the box below the time gap in months between completion of previous adjuvant immunotherapy and first diagnosis of disease relapse or
  • the patient has previously been treated with neoadjuvant immunotherapy for NSCLC and discontinued immunotherapy without disease progression and at least 6 months prior to the first diagnosis of relapse. Please document in the box below the time gap in months between completion of previous neoadjuvant immunotherapy and first diagnosis of disease relapse or
  • the patient has previously been treated with maintenance immunotherapy post chemoradiotherapy for NSCLC and discontinued immunotherapy without disease progression and at least 6 months prior to the first diagnosis of relapse. Please document in the box below the time gap in months between completion of previous maintenance immunotherapy and first diagnosis of disease relapse Time gap in months after completion of previous adjuvant or neoadjuvant or maintenance checkpoint inhibitor immunotherapy and first diagnosis of disease relapse:______ Note: the mandatory interval between the last date of administration of any prior adjuvant/neoadjuvant/maintenance immunotherapy and the date of first relapse is at least 6 months. For patients suffering a first relapse within 6-12 months of previous immunotherapy, clinicians should bear in mind the long elimination half-lives of immunotherapies and make individual assessments of the overall benefit/risk ratio of re-treatment with immunotherapy.
  1. The patient does not have a contra-indication to being treated with bevacizumab.
  2. The patient will be treated with a maximum of 4 x 3-weekly cycles of the combination of atezolizumab, bevacizumab (15mg/Kg), carboplatin (AUC 6mg/ml/min) and paclitaxel (200mg/m²). Note: a lower starting dose of paclitaxel 175mg/m²should be used in patients of Asian origin as per the SPC.
  3. After completion of the combination of atezolizumab, bevacizumab, carboplatin and paclitaxel and in the absence of disease progression, maintenance treatment with atezolizumab and bevacizumab will continue until loss of clinical benefit or unacceptable toxicity or withdrawal of patient consent or for a maximum treatment duration of 2* years, whichever occurs first. *2 years treatment is defined as a maximum of 35 x 3-weekly cycles of atezolizumab and bevacizumab including the initial 4 induction cycles of treatment. Note: atezolizumab in this maintenance treatment will be administered either subcutaneously at a dose of 1875mg every 3 weeks or intravenously at a dose of 1200mg every 3 weeks.
  4. The patient has a performance status of 0 or 1 and is fit for the combination of atezolizumab, bevacizumab, carboplatin (AUC 6mg/ml/min) and paclitaxel (200mg/m²). Note: the chemotherapy doses in this regimen are higher than may be the case in common practice and so careful selection of patients is required to ensure that patients can tolerate these higher doses of chemotherapy.
  5. The patient has no symptomatically active brain metastases or leptomeningeal metastases.
  6. A formal medical review as to whether treatment with the combination of atezolizumab, bevacizumab, carboplatin and paclitaxel should continue or not will be scheduled to occur at least by the end of the first 6 weeks of treatment.
  7. Where a treatment break of more than 12 weeks beyond the expected cycle length is needed, a treatment break form will be completed to restart treatment, including an indication as appropriate if the patient had an extended break because of COVID 19.
  8. Atezolizumab and bevacizumab will be otherwise used as set out in their respective Summaries of Product Characteristics.

NHS funded From: 05 July 2019

Form version:

CDF Managed Access: NA

NICE Technology Appraisal: TA584 (05 June 2019)

Current Form Version

Note

The data on this page was produced using version 1.361 of the CDF list, downloaded from an archive of NHS England’s website on 08 May 2025 at 22:10.

If NHS England has published a new version of the CDF List but this site has not yet accessed that, this form may be out of date. Additionally, if any update has occurred without NHS England noting it as a change, this page will be out of date.

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