Drug Action
Atezolizumab is a monoclonal antibody, which binds to the programmed death-ligand 1 (PD-L1), thereby reactivating the immune response to tumour cells.
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Drug reference
Atezolizumab is a monoclonal antibody, which binds to the programmed death-ligand 1 (PD-L1), thereby reactivating the immune response to tumour cells.
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Urothelial carcinoma (specialist use only) | Non-small cell lung cancer (specialist use only) | Small cell lung cancer (specialist use only) | Breast cancer (specialist use only) ▶BY INTRAVENOUS INFUSION ▶Adult: (consult product literature)
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Abnormal thyroid function—manufacturer advises to consider appropriate treatment. patients may need pre-medication to minimise the development of infusion-related reactions—consult product literature
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Manufacturer advises to record the brand name and batch number after each administration. All prescribers should be familiar with the Physician Information and Management Guidelines provided by the manufacturer. l HANDLING AND STORAGE Manufacturer advises store in a refrigerator (2–8°C); consult product literature for storage conditions after dilution.
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NICE decisions ▶Atezolizumab for untreated PD-L1-positive locally advanced or metastatic urothelial cancer when cisplatin is unsuitable (updated July 2018) NICE TA492 Atezolizumab (Tecentriq ®) is recommended for use within the Cancer Drugs Fund as an option for untreated locally advanced or metastatic urothelial carcinoma in adults, for whom cisplatin-based chemotherapy is unsuitable, only if: . their tumours express PD-L1 at a level of 5% or more, and . the conditions of the managed access agreement for atezolizumab are followed. Patients whose treatment was started within the NHS before this guidance was published should have the option to continue treatment, without change to their funding arrangements, until they and their NHS clinician consider it appropriate to stop. www.nice.org.uk/guidance/ta492 ▶Atezolizumab for treating locally advanced or metastatic urothelial carcinoma after platinum-containing chemotherapy (June 2018) NICE TA525 Atezolizumab is recommended as an option for treating locally advanced or metastatic urothelial carcinoma in adults who have had platinum-containing chemotherapy, only if: . atezolizumab is stopped at 2 years of uninterrupted treatment or earlier if the disease progresses, and . the company provides atezolizumab with the discount agreed in the patient access scheme. Patients whose treatment was started within the NHS before this guidance was published should have the option to continue treatment, without change to their funding arrangements, until they and their NHS clinician consider it appropriate to stop. www.nice.org.uk/guidance/ta525 ▶Atezolizumab for treating locally advanced or metastatic non- Immune system and malignant disease small-cell lung cancer after chemotherapy (May 2018) NICE TA520 Atezolizumab is recommended as an option for treating locally advanced or metastatic non-small-cell lung cancer (NSCLC) in adults who have had chemotherapy (and targeted treatment if they have an EGFR- or ALK-positive tumour), only if: . atezolizumab is stopped at 2 years of uninterrupted treatment or earlier if the disease progresses, and . the manufacturer provides atezolizumab with the discount agreed in the patient access scheme. Patients whose treatment was started within the NHS before this guidance was published should have the option to continue treatment, without change to their funding arrangements, until they and their NHS clinician consider it appropriate to stop. www.nice.org.uk/guidance/ta520 ▶Atezolizumab in combination for treating metastatic non- squamous non-small-cell lung cancer (June 2019) NICE TA584 Atezolizumab (Tecentriq ®) plus bevacizumab, carboplatin and paclitaxel is recommended as an option for metastatic non-squamous non-small-cell lung cancer (NSCLC) in adults: . who have not had treatment for their metastatic NSCLC before and whose PD-L1 tumour proportion score is between 0% and 49%, or . when targeted therapy for epidermal growth factor receptor (EGFR)-positive or anaplastic lymphoma kinase (ALK)-positive NSCLC has failed. It is recommended only if: . atezolizumab and bevacizumab are stopped at 2 years of uninterrupted treatment, or earlier if there is loss of clinical benefit (for atezolizumab) or if the disease progresses (for bevacizumab), and . the manufacturer provides atezolizumab and bevacizumab according to the commercial arrangements. Patients whose treatment was started within the NHS before this guidance was published should have the option to continue treatment, without change to their funding arrangements, until they and their NHS clinician consider it appropriate to stop. www.nice.org.uk/guidance/ta584 Scottish Medicines Consortium (SMC) decisions SMC No. 1336/18 The Scottish Medicines Consortium has advised (July 2018) that atezolizumab (Tecentriq ®) is accepted for restricted use within NHS Scotland for the treatment of adults with locally advanced or metastatic non-small cell lung cancer after prior chemotherapy, subject to a two-year clinical stopping rule. This advice is contingent upon the continuing availability of the patient access scheme in NHS Scotland or a list price that is equivalent or lower. SMC No. SMC2208 The Scottish Medicines Consortium has advised (November 2019) that atezolizumab (Tecentriq ®) is not recommended for use within NHS Scotland in combination with bevacizumab, paclitaxel and carboplatin, for the first- line treatment of adults with metastatic non-squamous non-small cell lung cancer, as the clinical and economic case was not demonstrated. SMC No. SMC2103 The Scottish Medicines Consortium has advised (November 2018) that atezolizumab (Tecentriq ®) is not recommended for use within NHS Scotland as monotherapy for the treatment of adults with locally advanced or metastatic urothelial carcinoma after prior platinum-containing chemotherapy, or who are considered cisplatin ineligible, as the clinical and economic case was not demonstrated.
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→Appendix 1: monoclonal antibodies
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▶Common or very common Abdominal pain. appetite decreased. arthralgia. ascites. asthenia. chills. cough. cystitis. cytokine release syndrome. diarrhoea. dysphagia . dyspnoea. electrolyte imbalance. euthyroid sick syndrome. eye disorders. fever. gastrointestinal disorders . goitre. hepatic disorders. hyperglycaemia. hypersensitivity. hypotension. hypothyroidism. hypoxia. increased risk of infection. influenza like illness. infusion related reaction. myalgia. myxoedema. nasal congestion. nausea. oesophageal varices. oesophageal varices haemorrhage. oropharyngeal complaints. pain. radiation pneumonitis. respiratory disorders. skin reactions. skin ulcer. throat irritation. thrombocytopenia. thyroid disorder. thyroiditis. toxic epidermal necrolysis. ulcerative colitis. vomiting ▶Uncommon Adrenal hypofunction. connective tissue disorders. diabetes mellitus. diabetic ketoacidosis. hyperthyroidism. ketoacidosis. meningitis. muscle abscess. myopathy. nerve disorders. pancreatitis. photophobia ▶Rare or very rare Hypophysitis. myocarditis. nephritis. neuromuscular dysfunction. temperature regulation disorder SIDE-EFFECTS, FURTHER INFORMATION Immune-related reactions Manufacturer advises most immune-related Immune system and malignant disease adverse reactions are reversible and managed by temporarily stopping treatment and administration of a corticosteroid—consult product literature. Infusion-related reactions Manufacturer advises permanently discontinue treatment in patients with severe infusion reactions.
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Manufacturer advises effective contraception in women of childbearing potential, during treatment and for 5 months after stopping treatment. See also Pregnancy and reproductive function in Cytotoxic drugs p. 938.
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Manufacturer advises avoid unless essential—no information available. See also Pregnancy and reproductive function in Cytotoxic drugs p. 938.
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Manufacturer advises avoid—no information available.
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Manufacturer advises monitor for signs and symptoms of infusion- and immune- related reactions—consult product literature.
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There can be variation in the licensing of different medicines containing the same drug. Solution for infusion EXCIPIENTS: May contain Polysorbates, sucrose ▶Tecentriq (Roche Products Ltd) A Atezolizumab 60 mg per 1 ml Tecentriq 840mg/14ml concentrate for solution for infusion vials | 1 vial P £2,665.38 Tecentriq 1200mg/20ml concentrate for solution for infusion vials | 1 vial P £3,807.69
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An alert card should be provided. Driving and skilled tasks Manufacturer advises patients should be counselled on the effects on driving and performance of skilled tasks—increased risk of drowsiness.
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(consult product literature)
First-line fragment. Read the complete Indications and Dose section above.
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