A Single-arm Trial of Atezolizumab/Platinum/Etoposide for the Treatment of Advanced Large-cell Neuroendocrine Cancer of the Lung

Inclusion Criteria:

1. Written informed consent

2. Patients with locally advanced or metastatic large-cell neuroendocrine carcinoma ofthe lung (LCNEC) without curative treatment options (patients with mixed histologyare eligible if LCNEC is the predominant histology i.e. ≥50%)

3. Previously untreated with systemic therapy (note: patients relapsing after curativeradio chemotherapy or adjuvant chemotherapy are eligible if relapse occurs ≥6 monthsafter discontinuation of curative treatment)

4. Planned treatment with Carboplatin or Cisplatin and Etoposide (SoC)

5. ECOG performance status: 0-2

6. age ≥18 years

7. measurable disease according to RECIST v1.1

8. adequate organ function defined as:

9. ALAT/ASAT ≤2.5x ULN or ≤3.5x ULN in case of liver metastases

10. Bilirubin ≤1.5x ULN or ≤2.5x ULN in case of liver metastases

11. Creatinine ≤1.5x ULN or Creatinine clearance according to Cockroft-Gault >60ml/min

12. Neutrophils ≥1 Gpt/l, Platelets >50 Gpt/l unless caused by bone marrowcarcinosis

Exclusion Criteria:

1. Symptomatic brain metastases (patients with asymptomatic brain metastases areallowed provided they are stable without steroid treatment for at least 3 weeks)

2. Severe autoimmune disease (patients with endocrine autoimmune disorders are allowedas long as they are on stable substitution treatment)

3. Severe uncontrolled infection

4. Prior treatment with either Atezolizumab or other immune checkpoint inhibitor

5. Any prior treatment for metastatic disease