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Treatment Name: Atezolizumab (Tecentriq®)

Atezolizumab (Tecentriq®) is an Immunotherapy Regimen for Bladder Cancer

How does Atezolizumab (Tecentriq®) work?
Atezolizumab is designed to enhance your immune system’s ability to target and specifically kill bladder cancer cells. Sometimes cancer cells have the ability to escape discovery from specific cancer-fighting cells known as T-cells. By attaching to cancer cells, atezolizumab helps your body’s T-cells recognize the cancer and kill it.

Goals of therapy:
Atezolizumab is given to patients with the goal of shrinking tumors, decreasing symptoms, and prolonging survival and is not commonly given with the goal of cure.

Schedule

  • Atezolizumab (Tecentriq®) intravenous infusion is usually given over 60 minutes on Day 1
    • If the first dose is tolerated, future doses may be infused over 30 minutes

Estimated total infusion time for this treatment:

  • Up to two hours for Cycle 1, Day 1; as short as one hour for the first day of next cycles if well tolerated
  • Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time

Atezolizumab is usually given in an outpatient infusion center, allowing the person to go home afterwards. It is repeated every 21 days. This is known as one Cycle.

Each cycle of atezolizumab is repeated until the drug no longer works or until unacceptable side effects occur. Duration of therapy depends upon response, tolerability, and number of cycles prescribed.

Click here for the common atezolizumab (Tecentriq®) starting dose.

Side Effects

In clinical studies, the most commonly reported atezolizumab (Tecentriq®) side effects are shown here:

  • Fatigue (30%)
  • Nausea (14%)
  • Decreased appetite (12%)
  • Itching (10%)
  • Fever (9%)
  • Diarrhea (8%)
  • Rash (7%)
  • Joint pain (7%)
  • Vomiting (6%)
  • Shortness of breath (3%)
  • Anemia [low red blood cells] (3%)
  • Lung tissue inflammation [cough or chest pain] (2%)
  • Low blood pressure (2%)
  • High blood pressure (1%)
  • Inflammation of small intestine or colon/large intestine (1%)

As many as 4% of patients stop atezolizumab (Tecentriq®) treatment due to unacceptable side effects.

Detailed information on Side Effects/Adverse Events:

  • In patients with bladder cancer, lung problems from atezolizumab are rare (about 1% of patients, onset: 15 days to 4.2 months). When severe breathing problems occurred, they lasted for as few as six days, but occasionally lasted up to three months
  • In patients with bladder cancer, liver inflammation from atezolizumab is rare (about 3% of patients, onset: 0.4 to 7.7 months)
  • In patients with bladder cancer, intestine (colon) inflammation is relatively common (about 19% of patients, onset: 1.1 to 3.1 months)

Side effect videos Side Effect Videos
Fatigue Fatigue Nausea and VomitingNausea and VomitingDiarrheaDiarrheaPainPainAnemiaAnemia

Monitoring

How often is monitoring needed?
Labs (blood tests) may be checked before treatment and periodically during treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), thyroid function, blood amylase levels, blood lipase levels, plus any others your doctor may order.

How often is imaging needed?
Imaging may be checked before treatment, then as often as every 9 weeks during treatment to assess response to atezolizumab, unless otherwise indicated. Imaging may include: magnetic resonance imaging (MRI), computerized tomography (CT) scans, or positron emission tomography (PET) scans. After 12 months, imaging may be performed once every 3 months.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue atezolizumab (Tecentriq®) as planned, or delay or switch therapy. If side effects from atezolizumab occur, a delay or change in therapy may be recommended. However, decreasing the dose of atezolizumab is not recommended.

ChemoExperts Tips

  • Because atezolizumab (Tecentriq®) enhances your immune system response to cancer, it may cause unintended side effects that are caused by the immune system and affect healthy cells as well. Some organs that can be affected include the thyroid, pituitary gland, adrenal glands, pancreas, gastrointestinal tract, liver, lungs, skin and eyes. A corticosteroid (e.g., prednisone) may be prescribed by your doctor to decrease symptoms if the immune system attacks healthy tissues during treatment
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for bladder cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Atezolizumab (Tecentriq®), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Atezolizumab (Tecentriq®). Depending upon your income, they may be able to help cover the cost of:

  • Atezolizumab

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Atezolizumab (Tecentriq®) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with Atezolizumab (Tecentriq®)

Individual Drug Label Information

Atezolizumab (Tecentriq®)

  • Atezolizumab (Tecentriq®) is an intravenous infusion
  • Doses may need to be delayed due to lung, liver, intestine, adrenal gland, thyroid, pituitary, eye, or other treatment-related problems
  • Inflammation of the lungs is rare, but serious if it occurs. Call your doctor immediately if you notice change in breathing, worsening cough, or chest pain as immediate treatment may be necessary
  • Liver inflammation may occur and is usually found through blood tests and may not cause any symptoms early in treatment. Atezolizumab therapy may need to be put on hold if this occurs, or steroid treatment may be started to help the liver recover. It may be possible to restart atezolizumab treatment if the liver fully recovers. Signs of liver problems may include yellowing of eyes or skin, pain on right side of abdomen, or easy bruising or bleeding
  • Intestine (colon) inflammation is relatively common and often causes diarrhea, with or without abdominal pain. Atezolizumab therapy may need to be put on hold if this occurs, or steroid treatment may be started to help the intestines recover. It may be possible to restart atezolizumab treatment if the intestines recover
  • Thyroid, adrenal gland, pancreas, or pituitary gland inflammation may occur, although all are relatively rare and occur in roughly 4% or fewer patients (1 out of every 25 patients)
  • Symptoms of thyroid problems may include: extreme tiredness, hair loss, weight loss or weight gain, feeling cold
  • Symptoms of adrenal gland problems may include: Dizziness, fatigue, low blood pressure, low blood sugar, difficulty with walking
  • Symptoms of pancreas problems may include: blood sugars that are difficult to control or abdominal pain, or frequent urination
  • Symptoms of pituitary gland problems may include: headache, vision problems, changes in hair, nails, or skin, and problems with other glands such as adrenals
  • Atezolizumab may be unsafe to receive if you are pregnant or breastfeeding. If you are a woman of child-bearing potential, tell you doctor immediately if you become pregnant while receiving atezolizumab. Women should not breastfeed for at least five months after the last dose of therapy
  • Women should also use effective contraception during treatment and for at least five months after the last dose
General side effects from atezolizumab (Tecentriq®)
  • Fatigue is the most common side effect reported with atezolizumab
  • Decreased appetite
  • Nausea
  • Infection, such as urinary tract infections or others. Report any fever, chills, flu-like symptoms, cough, or pain when urinating to your doctor immediately
  • Constipation
  • Skin reactions, such as itching or rash
  • Diarrhea is most often mild, but in some cases it can become severe when the digestive tract becomes inflamed. Watch for blood in stool or black tarry stools
  • Pain in joints
  • Vision problems
  • Click on the atezolizumab (Tecentriq®) package insert below for all reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaFatigue Fatigue ConstipationConstipationPainPainAnemiaAnemia

See DailyMed package insert.

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References

Rosenberg JE, Hoffman-Censits J, Powles T, et al. Atezolizumab in patients with locally advanced and metastatic urothelial carcinoma who have progressed following treatment with platinum-based chemotherapy: a single-arm, multicentre, phase 2 trial. Lancet. 2016;387:1909–1920.

Created: December 10, 2016 Updated: October 5, 2018

What is Bladder Cancer?

A disease of the cells that line the inside of the bladder. Bladder cancer is a rare disease that is most commonly seen in older adults. It is known to cause blood in the urine in up to 90% of patients at diagnosis. Causes of bladder cancer include smoking, exposure to certain chemicals (arylamines), and chronic bladder infections.

Treatment includes surgery (full or partial removal of the bladder), chemotherapy, immunotherapy (giving certain vaccines into the bladder), or thermotherapy (heating the lining of the bladder combined with chemotherapy). The stage of bladder cancer can vary at diagnosis and throughout treatment. Bladder cancer is staged using the Tumor, Node, Metastasis (TNM) system, as well as Stage Grouping 0, I, II, III, or IV. Staging systems describe the extent of cancer throughout the body and help doctors determine which treatments to offer. The effectiveness of the treatment may depend upon the stage at diagnosis.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What does Cure mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, doctors use the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.

Common Atezolizumab Starting Dose

  • Atezolizumab (Tecentriq®) 1,200 mg intravenous infusion is usually given over 60 minutes on Day 1
    • If the first dose is tolerated, future doses of 1,200 mg may be infused over 30 minutes

Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium

What is Amylase?

Amylase is an enzyme that is produced by the pancreas that helps the body break down and digest carbohydrates. When the pancreas is injured, amylase is leaked out into the blood. Amylase, along with lipase, can be monitored to check for possible injury to the pancreas, indicated by elevated levels of the enzymes in the blood.

What is Lipase?

Lipase is an enzyme that is produced by the pancreas that helps the body break down fats. When the pancreas is injured, lipase is leaked out into the blood. Lipase, along with amylase, can be monitored to check for possible injury to the pancreas, indicated by elevated levels of the enzymes in the blood.