What Is Atezolizumab?
Atezolizumab is a medicine used to treat cancer. It is a type of drug called a monoclonal antibody. It works on a protein called PD-L1 (programmed death-ligand 1), which is found on cancer cells. Atezolizumab is approved by the FDA as a second treatment for urothelial cancer. It is waiting for approval for non-small cell lung cancer. Doctors also use this drug to treat melanoma, small-cell lung cancer, and liver cancer (hepatocellular carcinoma).
Whom to Give Atezolizumab?
Atezolizumab can be given alone or with other cancer medicines, such as Bevacizumab, Cobimetinib, Vemurafenib, Paclitaxel, and Carboplatin.
How Does Atezolizumab Work?
Cancer cells use a protein called PD-L1 to hide from the immune system. Atezolizumab attaches to this protein. This helps the immune system see and attack cancer cells. It slows down the growth of cancer.
Dosage and Forms
Atezolizumab comes as a single-dose vial. Available strengths are 840 mg in 14 mL and 1200 mg in 20 mL. Both contain 60 mg per mL.
Dosage for Different Cancers
1. Small Cell Lung Cancer:
1200 mg given through a vein on day 1. It is given every 2nd, 3rd, or 4th week. Treatment continues until the cancer worsens or side effects become serious.
2. Liver Cancer (Hepatocellular Carcinoma):
Atezolizumab 1200 mg with Bevacizumab 15 mg/kg. It is given through a vein on day 1. It is repeated every 3 weeks. It is continued until the disease worsens or side effects become severe.
How Is the Drug Given?
Atezolizumab is given through a vein (intravenously). The first dose takes 60 minutes. Later doses take 30 minutes if the first dose is well tolerated. It is given every 2nd, 3rd, or 4th week. It must not be given as a quick injection. Other drugs should not be given through the same IV line.
Uses of Atezolizumab
Atezolizumab is used to treat:
- Extensive-stage small-cell lung cancer.
- Advanced or spreading urothelial cancer.
- Liver cancer (with Bevacizumab).
- Melanoma (with Cobimetinib and Vemurafenib).
- Metastatic non-small cell lung cancer (alone).
- Metastatic non-squamous lung cancer with other chemotherapy drugs.
For Patients
Before Starting Atezolizumab
This drug can sometimes harm normal organs in the body. Some side effects can be serious or life-threatening. Problems can happen during or after treatment.
When and How Often Is It Given?
Atezolizumab is given through a vein for 30 to 60 minutes. It is given every 2nd, 3rd, or 4th week. Only a healthcare professional can give it. Treatment may last up to two years. Your doctor decides the total treatment time.
Tell Your Doctor Before Taking Atezolizumab If You:
- Have had an organ transplant.
- Have immune diseases like Crohn’s disease or lupus.
- Have had or will have a stem cell transplant.
- Have had radiation to the chest.
- Are pregnant or planning a pregnancy.
- Are breastfeeding or planning to breastfeed.
- Take vitamins, herbal products, or other medicines.
After Starting Treatment
- Keep all doctor appointments.
- Do not miss doses.
- Doctors will check for side effects.
- Tests may be done to monitor your health.
- Treatment may be stopped if side effects are severe.
Possible Side Effects
1. When Used Alone
- Cough.
- Nausea.
- Loss of appetite.
- Shortness of breath.
- Tiredness.
2. When Used With Other Cancer Drugs
- Nausea.
- Diarrhea.
- Hair loss.
- Constipation.
- Loss of appetite.
- Tiredness.
3. In Liver Cancer
- Tiredness.
- High blood pressure.
- Protein in urine.
4. In Triple-Negative Breast Cancer
- Cough.
- Headache.
- Nausea and vomiting.
- Diarrhea or constipation.
- Low red blood cells.
- Low white blood cells.
- Hair loss.
- Tingling or numbness in the hands and feet.
5. In Melanoma
- Skin rash.
- Itching.
- Joint, muscle, or bone pain.
- Liver injury.
- Fever.
- Swelling of hands, feet, or mouth.
- Low thyroid hormone.
- Sunburn.
Missed Dose
If you miss an appointment, contact your doctor immediately. Reschedule as soon as possible.
Regular visits are very important.
Overdose
Overdose is very rare. The drug is given only by healthcare professionals. If an overdose occurs, one should contact the emergency department.
Storage
Store in a refrigerator at 2°C to 8 °C (degrees Celsius). Keep in original packaging. Protect from light. Do not freeze or shake the vial. Patients cannot store or use it themselves. Used vials are safely destroyed by medical staff.
For Doctors
Pharmacology
Mechanism of Action:
Atezolizumab is a humanized immunoglobulin G antibody that binds to the PD-L1 (programmed death ligand 1) and inhibits its attachment to the PD-1 and B7.1 receptors. PD-L1-mediated immune response inhibition gets released, activating an anti-tumor immune response sans antibody-dependent cellular cytotoxicity. PD-L1 activity blockade decreased tumor growth in mouse tumor models, providing rather striking mechanistic insights.
Pharmacodynamics:
Atezolizumab boasts unusually prolonged efficacy and is administered roughly every 3 or 4 weeks, rather than on infrequent dosing schedules.
Ingredients
Active Ingredient:
The active ingredient in this medicine is Atezolizumab.
Inactive Ingredients:
The inactive ingredients are glacial acetic acid, L-histidine, sucrose, polysorbate 20, and pharmacokinetics.
Absorption
Studies were done in patients with urothelial cancer. The AUC value ranged from 2.19 to 2.73 micrograms/mL. The Cmax value ranged from 0.27 to 0.35 micrograms/mL. These numbers show how much of the drug stays in the body after dosing.
Distribution
The drug spreads in the body with a volume of 6.91 liters. This medicine does not attach to normal blood proteins. It attaches only to PD-L1 on cancer cells. This helps reduce tumor growth.
Metabolism
Atezolizumab breaks down into small proteins and amino acids. This happens naturally inside the body.
Elimination
The drug is not removed by the kidneys. It stays in the body for about five months while breaking down.
Warnings and Precautions
Immune-Mediated Side Effects
This drug can cause the immune system to attack normal organs.
It can affect:
- Lungs (pneumonitis).
- Intestines (colitis).
- Liver (hepatitis).
- Hormone glands
- Skin.
- Kidneys.
- Transplanted organs.
Other serious immune reactions may affect:
- Heart.
- Blood vessels.
- Eyes.
- Brain and nerves.
- Pancreas.
- Muscles.
- Blood cells.
- Lymph nodes.
Doctors must monitor all organs closely. The drug may be stopped if reactions are severe.
Infusion-Related Reactions
Some patients may react during the infusion. The infusion may be slowed, stopped, or ended. This depends on how serious the reaction is.
Stem Cell Transplant Complications
Serious problems can occur if patients receive stem cell transplants. This can happen before or after Atezolizumab treatment. Possible problems include graft-versus-host disease and liver blood vessel disease. These patients must be monitored very carefully. Treatment should be stopped immediately if problems appear.
Pregnancy and Fetal Risk
Atezolizumab can harm an unborn baby. There are no studies in pregnant women. Animal studies show the immune system may reject the fetus. Women must be checked for pregnancy before treatment and use birth control during treatment.
Contraindications of Atezolizumab:
- Active infection.
- Low thyroid hormone.
- Overactive thyroid.
- Type 1 diabetes.
- Myasthenia gravis.
- Lung inflammation.
- Large intestine inflammation
- Adrenal gland problems.
- Liver inflammation.
- Muscle inflammation.
- Kidney inflammation.
- Pancreatitis
- Pituitary gland inflammation
- Pregnancy.
- Breastfeeding.
Drug Interactions
Atezolizumab can interact with other medicines. Drugs that reduce its effect include immunosuppressants and corticosteroids.
Use in Special Groups
-
Pregnancy:
The drug can cause fetal death. It should not be used during pregnancy.
-
Breastfeeding:
It is unknown if the drug enters breast milk. Do not breastfeed during treatment.
-
Children:
Safety in children is not fully known. No new safety problems have been reported so far.
-
Older Adults:
No major safety differences were seen in older patients.
-
Kidney Disease:
No dose change is needed for mild to moderate kidney disease. There is no data for severe kidney failure.
-
Liver Disease:
The drug is not recommended in severe liver disease. No dose change is needed for mild liver problems.
Conclusion
Atezolizumab is an advanced cancer medicine. It helps the immune system fight cancer. It is effective in lung cancer, liver cancer, and melanoma. However, it can cause serious immune side effects. Careful monitoring by doctors is very important. Talk to a cancer specialist for proper evaluation.
Key Takeaways
- Atezolizumab helps in the treatment of different kinds of cancer.
- It is given under medical supervision in the form of an injection.
- It is not advised during pregnancy or breastfeeding.
- It is recommended to visit a doctor in case of any side effects.
