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# **Atezolizumab**
## Overview
Atezolizumab is a humanized monoclonal antibody that targets programmed death-ligand 1 (PD-L1), inhibiting its interaction with PD-1 and B7.1 receptors. This blockade restores T-cell anti-tumor immune activity.
## Primary Indications
* Metastatic non-small cell lung cancer (NSCLC) with PD-L1 expression (in combination with chemotherapy or as monotherapy, depending on PD-L1 status and line of therapy).
* Urothelial carcinoma (UC) that is locally advanced or metastatic and has progressed during or after platinum-based chemotherapy, or is ineligible for cisplatin-based chemotherapy.
* Metastatic small cell lung cancer (SCLC) after prior platinum-based chemotherapy.
* Locally advanced or metastatic triple-negative breast cancer (TNBC) in combination with nab-paclitaxel.
## Adult Dosing
* **NSCLC:** 1200 mg intravenously (IV) every 3 weeks (21-day cycle).
* **UC:** 1200 mg IV every 3 weeks.
* **SCLC:** 1200 mg IV every 3 weeks.
* **TNBC:** 1200 mg IV every 3 weeks, in combination with nab-paclitaxel.
Infusion duration: Typically 60 minutes for the first infusion and 30 minutes for subsequent infusions if tolerated.
## Pediatric Dosing
Limited data available. Use is generally not recommended in pediatric patients unless reviewed by a specialist and benefits outweigh risks.
## Dose Adjustments
* No dose adjustments are required based on age, sex, or renal impairment.
* Hepatic impairment: Use with caution. No specific dose adjustment is recommended, but safety and efficacy have not been fully evaluated.
* Dosing may be interrupted or discontinued based on toxicity. Management of immune-related adverse events (irAEs) may involve corticosteroids.
## Contraindications
None established.
## Adverse Effects
Immune-related adverse events (irAEs) are common and can affect any organ system. These include:
* Pneumonitis
* Hepatitis
* Colitis
* Endocrinopathies (thyroid dysfunction, adrenal insufficiency, hypophysitis, type 1 diabetes mellitus)
* Nephritis
* Dermatologic reactions (rash, pruritus)
* Infusion-related reactions
* Fatigue
* Nausea
* Diarrhea
* Anemia
## Key Drug Interactions
* Immunosuppressants: May diminish the activity of atezolizumab.
* Corticosteroids: Concurrent use for irAE management may blunt the anti-tumor activity of atezolizumab. However, short-term use of corticosteroids for non-immune reasons is generally acceptable.
## Monitoring
* Monitor for signs and symptoms of irAEs (e.g., new or worsening dyspnea, cough, diarrhea, abdominal pain, jaundice, rash, neurological changes, endocrine symptoms).
* Baseline and periodic monitoring of liver function tests (ALT, AST, bilirubin), renal function tests (creatinine), and thyroid function tests (TSH, free T4) is recommended.
* Monitor for infusion-related reactions.
## Clinical Pearls
* Atezolizumab is administered every 3 weeks.
* Premedication is not routinely recommended.
* Dose interruption or discontinuation may be necessary for managing irAEs. The management often involves corticosteroids at doses appropriate for the severity of the irAE.
* The efficacy of atezolizumab in NSCLC depends on PD-L1 expression levels, which should be assessed prior to initiating therapy in certain patient populations.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for complete and up-to-date details before making prescribing decisions.
