What to Know About Tecentriq (Atezolizumab)

Tecentriq (atezolizumab) is an immunotherapy drug that works to fight off some types of cancer. Immunotherapy drugs affect the way the immune system responds to cancer growth. They also strengthen the immune system to help the body fight and destroy cancer cells. 

Keep reading to learn about Tecentriq, its uses, side effects, dosages, warnings, and precautions.

Uses

Tecentriq isn’t a chemotherapy drug. Rather, it is an immunotherapy drug, a type of drug that boosts the ability of the immune system to fight cancer cells. Chemotherapy, on the other hand, works to kill cancer cells. 

The Food and Drug Administration (FDA) has approved Tecentriq for the treatment of urothelial carcinoma, non-small cell lung cancer, small cell lung cancer, hepatocellular carcinoma (liver cancer), and melanoma. It can be used alone or with other chemotherapy medicines as a first-line treatment. 

Tecentriq targets a specific pathway called programmed-death-ligand 1 (PD-L1) which is found in some cancer cells. PD-L1 blocks normal immune system responses that generally kill cancer cells. By targeting PD-L1, Tecentriq activates your immune system’s ability to fight off cancerous cells.

Urothelial Carcinoma 

This type of cancer starts in the bladder. Bladder cancer cells grow abnormally and quickly. Tecentriq treats locally advanced or metastatic bladder cancer.

In some clinical studies, almost 15% of people taking Tecentriq had shrinkage of their tumors, and those improvements lasted for up to 13 months after treatment. One such study was done with patients who had previously been treated with platinum-based chemotherapy and yet had disease progression before beginning Tecentriq.

Lung Cancers

Tecentriq treats two types of lung cancer: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). 

SCLC is a fast-growing lung cancer that is usually caused by smoking. Tecentriq is used to treat extensive-stage SCLC along with two chemotherapy drugs—carboplatin and etoposide.

NSCLC is the most common type of lung cancer. It doesn’t grow as quickly as small cell lung cancer. For treating NSCLC, Tecentriq can be used alone or with other treatments. It is used as a first-line treatment for NSCLC that is metastasized and has PD-L1 proteins.

It is also indicated for the treatment of metastatic NSCLC that has been treated in the past with chemotherapy drugs, and it is sometimes used with other cancer therapies, such as the chemotherapy drugs bevacizumab, paclitaxel, and carboplatin.

Additionally, Tecentriq can be given as an adjuvant treatment following resection and platinum-based chemotherapy for those with Stage II to IIIA NSCLC whose tumors have PD-L1 proteins.

Melanoma

This type of skin cancer begins in the skin cells known as melanocytes. It can be more dangerous than other skin cancers because it can spread to the organs more rapidly if not treated in its early stages.

Tecentriq is used for melanoma that has a specific gene mutation (BRAF V600) which has spread from the skin to other parts of the body and cannot be removed with surgery. It is given in combination with two other drugs, Cotellic (cobimetinib), a tyrosine kinase receptor inhibitor drug, and Zelboraf (vemurafenib), a chemotherapy drug.

Hepatocellular Carcinoma (HCC)

HCC is the most common type of liver cancer. It often affects people with chronic liver diseases, including cirrhosis. Tecentriq is FDA approved to treat metastatic liver cancer or liver cancer that cannot be treated with surgery in those who have not previously received systemic (whole-body) therapies.

For liver cancer, it is given in combination with Avastin (bevacizumab).

Off-Label Uses

Tecentriq may be used off-label for other conditions. Off-label means a drug that has been FDA approved for a condition is used to treat another condition.

Off-label, Tecentriq has been used for renal cell carcinoma, a type of kidney cancer. One study reported in 2019 in the journal The Lancet found that Tecentriq plus bevacizumab could be effective for treating renal cell carcinoma.

In this study, researchers found that the combination treatment offered “prolonged progression-free survival,” compared to the chemotherapy drug sunitinib in people with metastatic renal carcinoma.

Atezolizumab plus bevacizumab also showed a favorable safety profile. The study’s authors supported the use of atezolizumab plus bevacizumab as a first-line therapy for some people with advanced renal cell carcinoma. They also recommended longer-term follow-up to establish a survival benefit.

Before Taking

Tecentriq is sometimes a first-line therapy for some types of cancer. Tecentriq is only available as a brand-name drug.

It comes as a solution that is diluted by a pharmacy and is given as an intravenous (IV) infusion. With an IV infusion, the drug is administered slowly into a vein using a needle, tubing, and an IV bag containing the medication. Doses typically take 30 to 60 minutes to administer.

When determining whether you’re a candidate for Tecentriq, your doctor will look at your overall health and any other medical conditions you might have.

You should also let your doctor know about other medications you take because some may interact with Tecentriq. This includes prescription and over-the-counter types, vitamins, herbs, and supplements. A drug interaction may change how Tecentriq works or increase the risk for side effects.

Precautions and Contraindications

Talk to your doctor about your health history before you take Tecentriq. Factors they consider might include:

• Allergic reactions: People who have had allergic reactions to Tecentriq or any of its ingredients should not take Tecentriq. Instead, ask your doctor about other medicines that might be better options.
• Immune system problems: Tecentriq works in the immune system to fight off cancer. That means that people with immune system conditions like rheumatoid arthritis, Crohn’s disease, ulcerative colitis, or lupus may not be able to take Tecentriq. Tecentriq can also affect the ability to fight off infections.
• Stem cell transplant: Serious complications and even death have been reported in people who have received stem cell transplants before or after using Tecentriq. If you need a stem cell transplant down the line, tell your doctor about your prior use of Tecentriq.
• Pregnancy: Tecentriq should not be used with pregnancy. It might cause the immune system to attack the developing fetus. Before prescribing Tecentriq, your doctor will want you to take a pregnancy test. Use effective birth control to prevent pregnancy while treating with Tecentriq.
• Breastfeeding: It is not known if Tecentriq passes through breast milk, so it is best to avoid breastfeeding while using Tecentriq.

Other Immunotherapies 

Immunotherapy drugs are cancer treatments that boost the body’s natural defenses to fight off cancer cells. These drugs use substances made by the body or in a laboratory setting to enhance the immune system’s ability to find and destroy cancer cells.

There are many types of immunotherapies, including immune checkpoint inhibitors, T-cell transfer therapy, monoclonal antibodies, treatment vaccines, and immune system modulators. The different types of immunotherapies work in different ways.

Some help the immune system stop or slow down the growth of cancer cells, while others destroy cancer cells and stop them from spreading. Immunotherapy can be used or combined with other treatments, including chemotherapy drugs.

The type of immunotherapy drug used, dosage, and treatment schedule depend on several factors, including the type of cancer being treated, its size and location, and if it has spread. Your doctor will also consider other factors, including your general health and body weight, and how you will cope with side effects.

Your doctor and healthcare team can answer specific questions about an immunotherapy treatment plan.

Dosage

Tecentriq comes as a solution that is administered by IV infusion. It is available in two strengths—840 mg/14 mL and 1,200 mg/20 mL. As an IV infusion, the drug is diluted in a pharmacy and administered slowly into a vein over some time.

Tecentriq infusions are given by a healthcare professional. For most people, the recommended dose can range from 840 mg to 1,680 mg by IV infusion over 60 minutes. If the initial infusion is tolerated, subsequent infusions can be delivered over 30 minutes. Treatments are given every two to four weeks "until disease progression or unacceptable toxicity.”

Dosages might be different based on the condition that is being treated. 

For cancers that Tecentriq has been approved to treat, the recommended dosage when it’s used alone or with other therapies may be given as one of the following: 840 mg every two weeks, 1,200 mg every three weeks, or 1,680 mg every four weeks.

If you miss an infusion treatment appointment for Tecentriq, call your doctor’s office to reschedule right away. To make sure you don’t miss cancer treatment appointments, try setting reminders on your phone.

You may need to take Tecentriq for the long term. It is meant to be taken for a long period. It is often taken until a person is unable to tolerate it or if the cancer doesn’t improve or gets worse. If your doctor determines Tecentriq is safe and effective, they will prescribe it for longer periods, sometimes a year or more.

Other Therapies Used With Tecentriq

Many people will need to take Tecentriq with other therapies to treat cancer. This is because some kinds of cancer need more than one type of cancer treatment.

For example, the chemotherapy drug bevacizumab is used to treat several types of cancer alongside Tecentriq. It can help to prevent the blood supply from reaching cancerous cells.

Other therapies commonly used with Tecentriq are:

• Carboplatin
• Etoposide
• Cotellic (cobimetinib)
• Zelboraf (vemurafenib)

Side Effects

Along with the wanted effects of Tecentriq, you may experience unwanted effects. Some side effects are more common, while others are less common and severe. Certain side effects can mean treatment delays or discontinuation of a medication.

Common Side Effects

Common side effects are mild and tend to go away after your body has gotten used to the drug’s effects. If these side effects become severe or persist, reach out to your doctor.

Common side effects of Tecentriq may include:

• Gastrointestinal issues (nausea, vomiting, loss of appetite, diarrhea, and/or constipation)
• Anemia
• Fever
• Liver problems
• Mouth sores
• High blood pressure
• Abnormal urine or blood testing
• Headache
• Fatigue
• Weakness
• Joint or muscle pain
• Swelling of the arms or legs
• Hair loss
• Rash or itching
• Sunburn or sensitivity to light

This is not a complete list of all common side effects. Call your doctor if you have questions or concerns about side effects while on Tecentriq.

Severe Side Effects 

You should reach out to your doctor if you experience any of the following more serious side effects:

• New or worsening cough
• Shortness of breath
• Chest pain
• Irregular heartbeat
• Severe stomach pain
• Bloody or tarry stools
• Swelling of the arms and legs
• Sores in the mouth, throat, or eyes
• Liver problems: Symptoms of a liver problem might include right-sided upper stomach pain, loss of appetite, fatigue, easy bruising or bleeding, dark urine, and jaundice (yellow skin or eyes).
• Infection: Signs of infection might include fever, flu symptoms, cough, back pain, and painful or frequent urination.
• Nervous system problems­: Signs of a nervous symptom problem might include neck stiffness, confusion, light sensitivity, vision problems, eye pain or redness, severe muscle weakness, numbness, or tingling of the hands or feet.
• A hormonal disorder: Signs might include frequent or severe headaches, dizziness, extreme fatigue, mood or behavioral changes, a deep or hoarse voice, increased thirst or hunger, increased urination, hair loss, feeling cold, weight gain, or weight loss.

You should seek emergency medical help for an allergic reaction to Tecentriq. Signs of a drug reaction include hives, breathing difficulties, swelling of the face, or a skin reaction, which can cause skin pain, red or purple rash, blistering, or peeling.

It is also possible to experience side effects during or after an infusion treatment. Tell your doctor or infusion provider right away if you feel dizzy, lightheaded, have chills, experience a fever, feel itchy, or have neck or back pain, trouble breathing, or swelling of your face during or following an infusion treatment.

Warnings and Interactions

You should let your doctor know any if you have or have had any of the following:

• An infection
• An immune system disorder, such as rheumatoid arthritis, lupus, or Crohn’s disease
• An organ transplant
• Radiation treatment to your chest
• A breathing disorder
• Liver disease
• A nervous system problem, such as myasthenia gravis or Guillain-Barré syndrome

Tecentriq can cause you to sunburn more easily. It is a good idea to avoid sunlight or tanning beds while treating with Tecentriq. Wear protective clothing and use sunscreen when you are outdoors.

If you would like to learn more about Tecentriq, talk to your doctor. Your doctor can answer your questions about side effects and whether Tecentriq might be an option for you.

Summary

Tecentriq is an immunotherapy drug that is used for certain types of cancer. It allows your immune system to attack some types of cancer cells. It is given as an infusion and is sometimes used in combination with other drugs.