atezolizumab at a glance
Class
PD-L1 immune-checkpoint inhibitor and monoclonal antibody
Main uses
Selected urothelial, lung, triple-negative breast and hepatocellular cancers
Administration
Given by a cancer specialist as an intravenous infusion or subcutaneous injection into the thigh
Key safety point
Immune-related inflammation can affect several organs and may appear after treatment ends
What is atezolizumab used for?
UK licences cover adults meeting indication-specific clinical, biomarker and previous-treatment criteria.
Locally advanced or metastatic urothelial carcinoma after platinum-containing chemotherapy, or in certain cisplatin-ineligible, PD-L1-positive patients.
Selected early-stage non-small-cell lung cancer after complete surgery and platinum-based chemotherapy, and selected advanced or metastatic non-small-cell lung cancers.
Extensive-stage small-cell lung cancer in combination with carboplatin and etoposide.
PD-L1-positive, unresectable locally advanced or metastatic triple-negative breast cancer in combination with nab-paclitaxel.
Advanced or unresectable hepatocellular carcinoma in combination with bevacizumab in patients without previous systemic treatment.
How does atezolizumab work?
PD-L1 on tumour or immune cells can switch off T-cell activity by binding PD-1 and B7.1. Atezolizumab binds PD-L1 and blocks these signals, releasing this immune-system brake and supporting an antitumour response.
atezolizumab preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 840 mg, 1200 mg
Injection
Route: Parenteral
Strengths: 1875 mg
How to take atezolizumab
Atezolizumab is administered by trained healthcare professionals in a hospital or clinic. It is not taken by mouth, so food does not affect administration.
The intravenous concentrate is diluted and given only as an infusion into a vein, not as a push or bolus.
The subcutaneous solution is ready to use, must not be diluted and is injected into alternating areas of the left or right thigh.
The formulations must be checked carefully to prevent administration by the wrong route.
Carry the supplied Patient Card and show it to healthcare professionals and caregivers.
atezolizumab side effects
Common or expected effects
- Tiredness or weakness
- Reduced appetite
- Nausea or vomiting
- Diarrhoea
- Rash or itching
- Fever
- Cough or shortness of breath
- Joint or back pain
- Headache
- Injection-site reaction with the subcutaneous formulation
- Blood-count changes, hair loss, constipation or peripheral neuropathy with some combination treatments
Get urgent medical advice
- Lung inflammation
- Bowel inflammation
- Liver inflammation
- Diabetes or ketoacidosis
- Neurological, muscular or eye inflammation
- Heart inflammation
- Kidney inflammation
- Severe skin reactions involving blistering, peeling or mucosal sores
- Administration-related reactions, including fever, chills, flushing or breathing difficulty
atezolizumab in pregnancy
Atezolizumab may harm a developing baby and should not be used during pregnancy unless specialist assessment concludes that treatment is clinically necessary. Anyone who could become pregnant should use effective contraception during treatment and for five months afterwards, and contact the oncology team promptly if pregnancy occurs or is planned.
atezolizumab while breastfeeding
It is unknown whether atezolizumab passes into human milk, and a risk to a breastfed child cannot be excluded. The oncology and maternity or infant-care teams should decide whether to stop breastfeeding or treatment after considering their respective benefits.
atezolizumab interactions
Formal pharmacokinetic interaction studies are limited, but immune-modifying treatments are clinically important.
Systemic corticosteroids
Routine systemic use before starting atezolizumab may interfere with its immune effect, although corticosteroids are used when clinically required to manage immune-related toxicity.
Other systemic immunosuppressants
Use before treatment should be reviewed because it may reduce atezolizumab's activity; specialist immunosuppression may still be required for toxicity.
Live attenuated vaccines
Tell the oncology team before vaccination because patients receiving recent live vaccines were excluded from clinical studies.
Common questions about atezolizumab
Answers are fully visible for fast scanning and source review.
Is atezolizumab chemotherapy?
No. It is an immune-checkpoint inhibitor, although it may be given alongside chemotherapy or other anticancer treatments.
Does every use require a PD-L1 test?
No. PD-L1 testing is required for particular licensed indications, but not all uses.
Can the intravenous and subcutaneous forms be switched?
Yes, when the treating clinician considers this appropriate.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.