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atezolizumab (Tecentriq)

Indications: - advanced bladder cancer (FDA-approved)* [1] - neoadjuvant atezolizumab with gemcitabine & cisplatin in patients with muscle-invasive bladder cancer [8] - non-small cell lung cancer after failure of or ineligibility for platinum-based chemotherapy [2] - overall survival with atezolizumab is 10.3 months vs 9.2 months single-agent chemotherapy - 2-year survival is 24% with atezolizumab vs 12% with chemotherapy [11] - 1st line in combination with bevacizumab + carboplatin + paclitaxel for treatment of lung adenocarcinoma [4] - maintenance therapy for metastatic small cell lung cancer - in combination with bevacizumab for treatment of metastatic renal cell carcinoma* [3] - treatment of unresectable locally advanced or metastatic triple-negative breast cancer in tumors expressing PD-L1 [5] - liver cancer (FDA-approved) - melanoma (FDA-approved) * no longer FDA-approved in the U.S. for bladder or urinary tract cancer [9] * continues FDA-approval for use in lung cancer, liver cancer & melanoma [9] Dosage: - IV infusion - SQ administration in the UK [10] Adverse effects: - most common - fatigue, anorexia, nausea, urinary tract infection, fever. pyrexia, constipation - serious - immune-mediated adverse effects involving lung, colon & endocrine system [1] Laboratory: - Ventana PD-L1 (SP142) assay complementary diagnostic for Tecentriq Mechanism of action: - targetd to PD-L1 pathway [1] Notes: - cost ~ $12,500/month 2016 [1]

Interactions

drug adverse effects of checkpoint inhibitor(s)

Related

programmed cell death 1 ligand 1; PD-L1; PDCD1 ligand 1; programmed death ligand 1; B7 homolog 1; B7-H1; CD274 (CD274, B7H1, PDCD1L1, PDCD1LG1, PDL1)

General

antineoplastic monoclonal antibody checkpoint inhibitor; immune checkpoint inhibitor; PD-1/PD-L1 inhibitor

References

  1. FDA News Release. May 18, 2016 FDA approves new, targeted treatment for bladder cancer. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm501762.htm
  2. West HJ Should Atezolizumab Be the First-Choice Immunotherapy in Second-Line Non-Small Cell Lung Cancer? Medcape Oncology. Oct 31, 2016 http://www.medscape.com/viewarticle/871119
  3. Fuerst ML with Expert Critique by Bowman IA Immunotherapy Plus Antiangiogenic Therapy Slows Growth of Advanced Kidney Cancer. Adding atezolizumab to bevacizumab delayed cancer growth by about 3 months longer than targeted therapy with sunitinib MedPage Today. 03.22.2018 https://www.medpagetoday.com/reading-room/asco/immunotherapy/71920
  4. Smith M. NSCLC Survival Rises with Checkpoint Blocker Add-On Atezolizumab plus standard therapy also slows disease progression. MedPage Today. June 04, 2018 https://www.medpagetoday.com/meetingcoverage/asco/73280 - Socinski MA, Jotte RM, Cappuzzo F et al Atezolizumab for first-line treatment of metastatic nonsquamous NSCLC. N Engl J Med. 2018 Jun 4. PMID: 29863955 - Socinski MA et al Overall survival (OS) analysis of IMpower150, a randomized Ph 3 study of atezolizumab (atezo) + chemotherapy (chemo) +/- bevacizumab (bev) vs chemo + bev in 1L nonsquamous (NSQ) NSCLC. American Society of Clinical Oncology (ASCO) 2018; Abstract 9002
  5. FDA Approval Notice. March 8, 2019 FDA approves atezolizumab for PD-L1 positive unresectable locally advanced or metastatic triple-negative breast cancer. https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm633065.htm
  6. Marin-Acevedo JA, Chirila RM, Dronca RS. Immune Checkpoint Inhibitor Toxicities. Mayo Clinic Proc. July 2019. 94(7):1321-1329 PMID: 31272574
  7. Davenport L Which Patients Benefit Most From Adjuvant Atezolizumab in NSCLC? Medscape. September 11, 2021 https://www.medscape.com/viewarticle/958588
  8. Bassett M Pre-Op Atezolizumab Promising in Muscle-Invasive Bladder Cancer Over two-thirds downstaged to non-muscle-invasive disease with PD-L1 inhibitor plus chemotherapy. MedPage Today February 7, 2022 https://www.medpagetoday.com/hematologyoncology/othercancers/97053 - Funt SA, Lattanzi M, Whiting K et al Neoadjuvant Atezolizumab With Gemcitabine and Cisplatin in Patients With Muscle-Invasive Bladder Cancer: A Multicenter, Single-Arm, Phase II Trial. J Clin Oncol. 2022. Jan 28. PMID: 35089812 https://ascopubs.org/doi/abs/10.1200/JCO.21.01485
  9. Chustecka Z Atezolizumab (Tecentriq) Bladder Cancer Indication Withdrawn in US. Medscape. Nov 29, 2022 https://www.medscape.com/viewarticle/984722
  10. Hicks R NHS 'World First' Cancer Injection Roll-Out. Medscape UK. August 30, 2034 https://www.medscape.co.uk/viewarticle/nhs-world-first-cancer-injection-roll-out-2023a1000k5z
  11. Lee SM et al. First-line atezolizumab monotherapy versus single-agent chemotherapy in patients with non-small-cell lung cancer ineligible for treatment with a platinum- containing regimen (IPSOS): A phase 3, global, multicentre, open-label, randomised controlled study. Lancet 2023 Aug 5; 402:451. PMID: 37423228 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00774-2/fulltext