Atezolizumab (Tecentriq)

How is this drug name pronounced?

Atezolizumab: A-teh-zoh-LIZ-yoo-mab

Tecentriq: teh-SEN-trik


What cancer(s) does this drug treat?

Tecentriq has been approved for a number of cancer types and stages, in some cases as a single therapy and in some cases in combination with other therapies.

Tecentriq is approved for:

Bladder and urinary tract (urothelial cell) cancer
Advanced non-small cell lung cancer
Small cell lung cancer
Triple-negative breast cancer
Liver cancer
Melanoma

Advanced bladder and urinary tract (urothelial cell) cancer

Tecentriq is approved for:

Patients with advanced urothelial carcinoma (the most common type of bladder and urinary tract cancer) that has grown or spread and cannot be removed by surgery AND:

  • whose cancer tests positive for the PD-L1 molecule and who cannot be treated with a chemotherapy containing cisplatin, OR
  • who cannot be treated with any chemotherapy containing platinum, OR
  • who have been treated with chemotherapy containing platinum, but it did not work or stopped working.

Advanced non-small cell lung cancer

Tecentriq is approved for:

  • Patients with nonsquamous non-small cell lung cancer that has spread and does not have an abnormal EGFR or ALK gene. In such cases, Tecentriq may be used in combination with bevacizumab (Avastin, Mvasi, Zirabev), paclitaxel (Taxol or Onxal), and carboplatin (Paraplatin) as a first treatment. Alternatively, Tecentriq may be used in combination with paclitaxel protein-bound (Abraxane) and carboplatin (Paraplatin) as a first treatment.
  • Patients with non-small cell lung cancer that has spread, whose tumors test positive for high levels of the PD-L1 molecule, and whose tumors do not have an abnormal EGFR or ALK gene. In such cases, Tecentriq is used as a first treatment.
  • Patients with non-small cell lung cancer that has spread. The patient must have already tried chemotherapy containing platinum and it either did not work or stopped working. If the patient’s tumor has an abnormal EGFR or ALK gene, the patient has to have also tried therapy for tumors with such abnormal genes prior to receiving Tecentriq.

Advanced small cell lung cancer

Tecentriq is approved for:

  • Patients with extensive-stage small cell lung cancer that has grown or spread. In such cases, Tecentriq may be used in combination with chemotherapies carboplatin (Paraplatin) and etoposide (Etopophos) as a first treatment.

Advanced triple-negative breast cancer

Tecentriq is approved for:

  • Patients with triple-negative breast cancer that has grown or spread, cannot be removed by surgery, and tests positive for the PD-L1 molecule. In such cases, Tecentriq may be used in combination with paclitaxel protein-bound (Abraxane).

Advanced liver cancer

Tecentriq is approved for:

  • Patients with liver cancer (hepatocellular carcinoma) that could not be removed by surgery or has spread to other parts of the body, and who have not yet received systemic therapy (therapy by mouth or injection into the vein [I.V.]) for their disease. In such cases, Tecentriq is used in combination with bevacizumab (Avastin, Mvasi, Zirabev).

Advanced melanoma

Tecentriq is approved for:

  • Patients with melanoma that could not be removed by surgery or had spread to other parts of the body, and who tested positive for the BRAF V600 mutation. In such cases, Tecentriq is given in combination with cobimetinib (Cotellic) and vemurafenib (Zelboraf).

Limitations of use:

Age: The safety and efficacy of Tecentriq in patients under 18 years of age have not been established.
Fertility/Pregnancy/Breastfeeding: Tecentriq may impair fertility in women while receiving treatment. Tecentriq can cause harm to a fetus, and is not recommended for use during pregnancy. Pregnancy should be prevented for at least five months after the last dose of Tecentriq. The risks associated with Tecentriq during breastfeeding are not known and cannot be ruled out. Due to the potential for serious adverse reactions in the breastfed child, women are advised not to breastfeed during treatment and for at least five months after the last dose of Tecentriq.


What type of immunotherapy is this?

Checkpoint blockade

  • PD-L1 blockade

How does this drug work?

  • Target: PD-L1

Tecentriq is an antibody that attaches to a molecule called PD-L1, which is sometimes present on the surface of cancer cells or other cells within the tumor mass. PD-L1 interacts with a molecule called PD-1, which is present on the surface of T cells– the primary immune cells involved in killing cancer cells. In healthy tissues, the interaction between PD-L1 and PD-1 puts on a brake that keeps T cells from creating an immune reaction that gets out of control. However, cancers can hijack this safety mechanism and prevent T cells from doing their job – killing the cancer cells. When PD-L1 interacts with PD-1 on T cells, the T cells become inactive and do not attack the cancer cells. Tecentriq binds to the PD-L1 molecules on cancer cells and other cells within the tumor mass in such a way that it blocks the interaction between PD-1 and PD-L1, and allows the T cells to be active and attack the cancer cells.

Illustration that shows how Tecentriq works


How is this drug given to the patient?

Tecentriq is administered via a tube into a vein (intravenous infusion, or I.V.) over 60 minutes every two, three, or four weeks (depending on the dose) and does not require a hospital stay. If the first infusion is tolerated, all following infusions may be administered over 30 minutes.


What are the observed clinical results?

For:

Advanced bladder and urinary tract (urothelial cell) cancer
Advanced non-small cell lung cancer (previously untreated with chemotherapy)
Advanced non-small cell lung cancer (previously treated with chemotherapy)
Advanced small cell lung cancer
Advanced triple-negative breast cancer
Advanced liver cancer
Advanced melanoma

It is important to keep in mind that each patient’s actual outcome is individual and may be different from the results found in the clinical studies. In addition, with immunotherapy, sometimes it takes several months for responses to be observed.

Advanced bladder and urinary tract (urothelial cell) cancer

In a clinical trial, in a group of 119 patients with advanced bladder cancer that had grown or spread and who could not be treated with cisplatin (a chemotherapy), at a median follow-up of 17 months following treatment with Tecentriq:

Results following treatment with Tecentriq (diagram)

In the same clinical trial, in a group of 310 patients with advanced bladder cancer that had grown or spread and who had been treated with chemotherapy containing platinum, but it did not work or stopped working, at a median follow-up of 33 months following treatment with Tecentriq:

Results following treatment with Tecentriq (diagram)

Advanced non-small cell lung cancer (previously untreated with chemotherapy)

In a clinical trial of patients with nonsquamous non-small cell lung cancer that had spread and who had not previously been treated with chemotherapy for their advanced disease, patients were treated with one of the following three treatment options:

  • Treatment 1: Tecentriq in combination with paclitaxel (Taxol or Onxal) and carboplatin (Paraplatin)
  • Treatment 2: Tecentriq in combination with bevacizumab (Avastin), paclitaxel (Taxol or Onxal), and carboplatin (Paraplatin)
  • Treatment 3: bevacizumab (Avastin), paclitaxel (Taxol or Onxal), and carboplatin (Paraplatin)

In the 1045 of 1202 enrolled patients whose cancer did not have an abnormal EGFR or ALK gene, at a median follow-up of 20 months, the following results were observed for patients receiving either Treatment 2 or 3:

(Results for patients receiving Treatment 1 did not significantly differ from the results observed with Treatment 3, and the combination used in the Treatment 1 arm did not receive approval.)

Results for 3 different treatments (diagram)

In another clinical trial of patients with nonsquamous non-small cell lung cancer that had spread and who had not previously been treated with chemotherapy for their advanced disease, patients were treated with either a combination of Tecentriq, paclitaxel protein-bound (Abraxane), and carboplatin (Paraplatin) or a combination of paclitaxel protein-bound (Abraxane) and carboplatin (Paraplatin). In the 679 of 724 enrolled patients whose cancer did not have an abnormal EGFR or ALK gene, at a median follow-up time of 19 months after treatment:

Results (diagram)

In another clinical trial, 205 patients with non-small cell lung cancer that had spread, whose tumors tested positive for high levels of the PD-L1 molecule, and whose tumors did not have an abnormal EGFR or ALK gene, were treated with either Tecentriq or platinum-based chemotherapy as first therapy. At a median follow-up of 16 months:

Results for Tecentriq and platinum-based chemo (diagram)

Advanced non-small cell lung cancer (previously treated with chemotherapy)

In a clinical trial of patients with non-small cell lung cancer that had grown or spread and who had already tried chemotherapy containing platinum, but it either did not work or stopped working, patients were treated with either Tecentriq or docetaxel (a chemotherapy). In the first 850 treated patients, at a median follow-up of 21 months following treatment:

Results for patients treated with either Tecentriq or docetaxel (diagram)

Advanced small cell lung cancer

In a clinical trial of 403 patients with extensive-stage small cell lung cancer that had grown or spread and who had not been treated with chemotherapy for their advanced disease, patients were treated with either Tecentriq in combination with the chemotherapies carboplatin (Paraplatin) and etoposide (Etopophos), or with a placebo in combination with carboplatin (Paraplatin) and etoposide (Etopophos). At a median follow-up of 14 months following treatment:

Results (diagram)

Advanced triple-negative breast cancer

In a clinical trial of 902 patients with triple-negative breast cancer that had grown or spread and could not be removed by surgery, and who had not been treated with chemotherapy for their advanced disease, patients were treated with either Tecentriq in combination with paclitaxel protein-bound (Abraxane) or with a placebo in combination with paclitaxel protein-bound (Abraxane). In 369 patients whose cancer tested positive for high levels of the PD-L1 molecule, at a median follow-up of 13 months following treatment:

Results with Tecentriq with Abraxane vs placebo with Abraxane (diagram)

Advanced liver cancer

In a clinical trial, 501 patients with liver cancer (hepatocellular carcinoma) that could not be removed by surgery or had spread to other parts of the body, and who had not received systemic therapy (therapy by mouth or injection into the vein [I.V.]) for their disease, were treated with either Tecentriq plus bevacizumab (Avastin, Mvasi, Zirabev) OR sorafenib (Nexavar). At a median follow-up of 9 months:

Results Tecentriq vs Sorafenib for liver cancer (diagram)

Advanced melanoma

In a clinical trial, 514 patients with melanoma that could not be removed by surgery or had spread to other parts of the body, and who tested positive for the BRAF V600 mutation, were treated with cobimetinib (Cotellic) and vemurafenib (Zelboraf) for 28 days and then received either Tecentriq plus cobimetinib and vemurafenib, or placebo plus cobimetinib and vemurafenib. At a median follow-up 19 months:

Results after treatment with Tecentriq and cobimetinib and vemurafenib vs placebo and cobimetinib and vemurafenib (diagram)


What are the side effects?

The most common side effects of Tecentriq include fatigue, weakness, nausea, decreased appetite, cough, and shortness of breath. When Tecentriq is used in combination with other drugs, other common side effects include diarrhea, constipation, vomiting, hair loss, headache, tingling or numbness in hands or feet, pain (in the muscles, bones, and joints), skin rash, heightened skin sensitivity to sunlight, low red blood cell count (anemia), and low white blood cell count.

Tecentriq can cause the patient’s T cells to attack healthy cells throughout the body. Because of this, Tecentriq can cause side effects that can become serious or life-threatening, and may lead to death. Some of the serious side effects related to Tecentriq include inflammation of the lungs, liver, or colon. Additionally, problems can arise with the heart, vision, and hormone glands (including thyroid, pituitary, and adrenal glands, as well as the pancreas). Skin blisters and reactions related to the infusion may also occur. Patients should report any symptoms to their healthcare provider, who can then initiate actions to limit or reverse the side effects.

For a more complete list of possible side effects, see the full prescribing information.


Additional information


Understanding Cancer Immunotherapy Research

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