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Tecentriq (atezolizumab)

In October 2016, the U.S. Food and Drug Administration (FDA) approved Tecentriq® (atezolizumab) for the treatment of metastatic non-small cell lung cancer (NSCLC) in people whose disease has progressed after being treated with chemotherapy containing platinum. Patients having EGFR or ALK tumor aberrations should also have progression with approved therapy for NSCLC with these abnormal genes before treatment with atezolizumab. Atezolizumab is the first approved anti-PD-L1 immunotherapy. In addition, atezolizumab is approved for extensive-stage SCLC as first line-treatment in addition to the chemotherapy drugs etoposide and carboplatin. 1

Atezolizumab has also been approved in combination with bevacizumab and chemotherapy (paclitaxel and carboplatin) for the first-line treatment of patients with metastatic non-squamous NSCLC with no EGFR or ALK genomic tumor aberrations.4

In 2019, the FDA approved the use of atezolizumab for the initial treatment of extensive-stage small cell lung cancer (ES-SCLC) in addition to chemotherapy. It’s approval for use as a first line treatment for ES-SCLC is historic, as there have not been any new treatment options approved specifically for this group of individuals in the past 20 years.5

Researchers have identified several pathways where cancer cells suppress the T-cell immune response. One of the pathways that is affected in some people with NSCLC is the PD-1 receptor and the molecules which bind to the receptor, PD-L1 and PD-L2. When this pathway is affected by the cancer cells, the cancer can grow and spread without being kept in check by T-cells. Atezolizumab targets the PD-L1 pathway. By blocking this pathway, atezolizumab may help the body’s own immune system to fight the cancer.1,2

Receiving atezolizumab

Atezolizumab is given as an infusion that is administered through an IV (intravenous) line over 60 minutes. It is usually given once every three weeks. If the first infusion is well tolerated, future doses may be given over 30 minutes.2

Side effects of atezolizumab

Atezolizumab may cause side effects, and in some cases, these side effects can be serious. Any side effects should be reported to a health care professional. The most common side effects experienced by patients taking atezolizumab for NSCLC were fatigue (46% of patients), decreased appetite (35%), shortness of breath (32%), cough (30%), nausea (22%), musculoskeletal pain (22%), and constipation (20%). Less common side effects included pulmonary embolism, pneumonia, pneumothorax, bleeding ulcer, difficulty swallowing, heart attack, or large intestinal perforation, which led to death.1

Possible serious side effects with atezolizumab include lung problems (such as pneumonitis), liver problems (such as hepatitis), intestinal problems (such as colitis), hormone gland problems (especially the pituitary, thyroid, adrenal glands and pancreas), nervous system problems (such as neuropathy, meningitis and encephalitis), eye problems (such as inflammation), severe infections (such as sepsis and encephalitis), and severe infusion reactions.1,3

Precautions

Patients receiving atezolizumab should talk to their doctor about other medications, herbal remedies, and any supplements they are taking, as well as any other health conditions. Patients who are pregnant or may become pregnant during treatment should discuss their condition with their doctor prior to starting atezolizumab, as it may be hazardous to the fetus. It is not recommended for women to conceive a child while taking atezolizumab, and patients are advised to use contraception during treatment and for at least five months after treatment is completed. It is not known whether atezolizumab passes into breast milk, and patients should not breastfeed while taking Tecentriq.3

Written by: Emily Downward | Last reviewed: April 2019.
  1. Genentech, Inc. Accessed online on 11/3/16 at https://www.gene.com/media/press-releases/14641/2016-10-18/fda-approves-genentechs-cancer-immunothe.
  2. Immunotherapy in Lung Cancer Treatment: Current Status and Future Directions, American Society of Clinical Oncology. Accessed online on 9/30/16 at https://am.asco.org/immunotherapy-lung-cancer-treatment-current-status-and-future-directions.
  3. Tecentriq product website, Genentech, Inc. Accessed online on 11/3/16 at https://www.tecentriq.com/hcp/nsclc/index.html
  4. FDA. FDA approves atezolizumab with chemotherapy and bevacizumab for first-line treatment of metastatic non-squamous NSCLC. Accessed December 7, 2018. https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm627874.htm?utm_campaign=Oncology%2012%2F06%2F2018%20Atezolizumab-bevacizumab&utm_medium=email&utm_source=Eloqua&elqTrackId=3c51932714b64c83b8480472e878b65e&elq=2c747991d85640eeb7b47db13f35a63a&elqaid=6195&elqat=1&elqCampaignId=5030
  5. FDA Approves Atezolizumab for Extensive-Stage Small Cell Lung Cancer. United States Food and Drug Administration. https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm633814.htm. Published March 18, 2019. Accessed March 21, 2019.