Atezolizumab (Tecentriq)

Atezolizumab is a type of immunotherapy. You pronounce atezolizumab as a-teh-zoh-liz-you-mab. It is also called Tecentriq.

You may have it as a treatment on its own for:

• non small cell lung cancer (NSCLC)
• a type of urinary system cancer called urothelial cancer (also called transitional cell cancer) 

Some people may have atezolizumab as part of a clinical trial. Or in combination with other cancer drugs for other types of cancer.

This page is about having atezolizumab on its own. 

How does atezolizumab work?

Atezolizumab is a type of immunotherapy called a checkpoint inhibitor. It works by blocking a protein called PD-L1. PD-L1 stops the immune system from working properly and attacking cancer cells. Atezolizumab helps your immune system find and kill the cancer cells. 

How do you have atezolizumab?

Most people have atezolizumab as an injection under the skin (subcutaneously).

Some people may have it as a drip into the bloodstream. This is normally if they can’t tolerate it as an injection under the skin.

Injection under your skin (subcutaneous injection)

You usually have atezolizumab as an injection under the skin into your thigh.

You might have stinging or a dull ache for a short time after this type of injection but they don't usually hurt much. The skin in the area may go red and itchy for a while.

Into your bloodstream

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

How often do you have atezolizumab?

You have atezolizumab as cycles of treatment. This means that you have the drug and then a rest to allow your body to recover.

If you are having atezolizumab as an injection under your skin, you normally have it every 3 weeks.

If you are having it into your bloodstream, you might have it every 2 to 4 weeks.

How long you have atezolizumab for depends on:

• the cancer type
• if the cancer has spread
• what treatments you have already had
• how long the treatment works for
• the side effects not being too bad

Your healthcare team will tell you more about this. 

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Before treatment starts you may have a blood test to check for viruses such as hepatitis B, hepatitis C, and HIV . This is called a viral screen.

It’s important for your doctor to know if you have had any of these viruses. This is because this treatment can weaken your immune system and can cause the virus to become active again (reactivation). 

What are the side effects of atezolizumab?

Side effects can vary from person to person. They also depend on what other treatment you are having. 

When to contact your team

Your doctor, pharmacist or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

High temperature (fever)

Tell your healthcare team straightaway if you get a high temperature. Ask them if you can take paracetamol to help lower your temperature.

Difficulty breathing

You may have difficulty breathing or a cough. Sometimes you might get both. Occasionally this can be caused by changes to the lung tissue, which make it less flexible.

Let your healthcare team know straight away if you have either of these symptoms. 

Fatigue

Tiredness and weakness (fatigue) can happen during and after treatment. Doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Loss of appetite

You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Skin changes

You might notice skin changes, such as dryness, itching, blisters and rashes similar to acne on your face, neck and trunk. 

Tell your doctor if you have any rashes or itching. Don't go swimming if you have a rash because the chlorine in the water can make it worse.

If your skin gets dry or itchy, using unperfumed moisturising cream may help. Check with your doctor or nurse before using any creams or lotions. Wear a high factor sun block if you’re going out in the sun.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Diarrhoea and inflamed bowel

You might get diarrhoea. Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

Your bowel may also become inflamed and swollen. This can be serious.

Joint or back pain

You might have pain in your back or joints. Speak to your doctor or nurse about what painkillers you can take to help with this.

Urinary tract infections (UTIs)

Tell your doctor or nurse if you think you might have a urinary tract infection. You might find it difficult to pass urine, want to go with some urgency or are going more often. There may be pain or burning when you go. You may see blood in your urine, or your urine might smell bad or look cloudy.

Headache

Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness - some allergic reactions can be life threatening. Alert your nurse if you notice any of these symptoms
• changes in your blood tests showing low levels of potassium and sodium
• low blood pressure – you might feel dizzy, lightheaded or faint
• liver changes such as liver inflammation (hepatitis) - symptoms may include jaundice , feeling or being sick, bleeding or bruising, dark urine, and stomach pain. You have regular blood tests to check how well your liver is working
• changes to the way your thyroid gland works – it may make too much or not enough thyroid hormone. You may have regular blood tests to check this
• flu-like symptoms
• pain in your abdomen
• low platelets which makes you bruise and bleed easily
• pain in your muscles or bones (musculoskeletal pain)
• high blood sugar levels
• numbness or tingling in fingers or toes (peripheral neuropathy) - this is often temporary and can improve after you finish treatment
• problems with the smooth sheet of body tissue that surrounds the heart (pericardium)
• dry mouth
• pain in your mouth and throat
• your nose feeling blocked, a runny nose and you might also have a sore throat
• difficulty in swallowing
• high levels of creatinine - a waste product made by the muscles. You have blood tests to check the levels
• a reaction where you had the injection if you are having atezolizumab under the skin

Rare side effects

These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:

• inflammation of your pancreas - you might not have any symptoms but changes may be picked up on a blood test
• your adrenal glands not making enough important hormones (cortisol and aldosterone)
• inflammation of the brain
• the immune system attacking the nervous system (Guillain-Barre syndrome) - causes numbness, weakness and pain in the body. Go to A&E if you have any numbness or are unable to move
• severe skin reactions that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening
• muscle weakness
• inflammation of the kidneys
• pituitary gland  problems that can cause fatigue, vision problems and headaches
• pancreas stops making enough insulin (diabetes)

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Loss of fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Pregnancy and contraception

This drug may harm a baby developing in the womb. It is important not to become pregnant while you are having treatment and for 5 months afterwards.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you become pregnant while you're having treatment.

Breastfeeding

It is not known whether this drug comes through into the breast milk. Speak to your doctor if you are breastfeeding.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having.

Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, and yellow fever.

You can usually have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine

Talk to your doctor or pharmacist about the best time to have a vaccine in relation to your cancer treatment.

Contact with others who have had immunisations 

You can be in contact with other people who have had live vaccines as injections. If someone has had a live vaccine by mouth or nasal spray there may be a small risk the vaccine virus can be passed onto you if your immune system is weakened.

Your healthcare team will let you know if you need to take any precautions if you are in close contact with someone who has had a live vaccine.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.