Classification: PDL-1 blocking antibody
About Atezolizumab (Tecentriq™)
Atezolizumab is a programmed death ligand 1 (PDL-1) blocking antibody. It is an engineered monoclonal antibody that binds to certain proteins and activates the body’s immune response against the tumor, slowing tumor growth.
How to Take Atezolizumab
Atezolizumab is a given by an intravenous (IV, into a vein) infusion. The usual dose is 1200mg every 3 weeks. The first dose is given over 60 minutes and, if it is well tolerated, subsequent doses are given over 30 minutes.
Possible Side Effects
There are a number of things you can do to manage the side effects of atezolizumab. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:
The infusion can cause a reaction that can cause chills, fever, itching, rash, flushing, shortness of breath, dizziness, or facial swelling. Notify your infusion nurse if you notice any change in how you feel during the infusion.
Nausea and/or Vomiting
Talk to your doctor or nurse so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms.
Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.
There are several things you can do to prevent or relieve constipation. Include fiber in your diet (fruits and vegetables), drink 8-10 glasses of non-alcoholic fluids a day, and keep active. A stool softener once or twice a day may prevent constipation. If you do not have a bowel movement for 2-3 days, you should contact your healthcare team for suggestions to relieve the constipation.
Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.
You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal. The most common infection related to this medication is a urinary tract infection. Symptoms of urinary tract infection include frequency, urgency and burning with urination.
Tips to preventing infection:
- Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
- Avoid large crowds and people who are sick (i.e.: those who have a cold, fever or cough or live with someone with these symptoms).
- When working in your yard, wear protective clothing including long pants and gloves.
- Do not handle pet waste.
- Keep all cuts or scratches clean.
- Shower or bath daily and perform frequent mouth care.
- Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
- Ask your doctor or nurse before scheduling dental appointments or procedures.
- Ask your doctor or nurse before you, or someone you live with, has any vaccinations.
Decrease in Appetite
Nutrition is an important part of your care. Cancer treatment can affect your appetite and, in some cases, the side effects of treatment can make eating difficult. Ask your nurse about nutritional counseling services at your treatment center to help with food choices.
- Try to eat five or six small meals or snacks throughout the day, instead of 3 larger meals.
- If you are not eating enough, nutritional supplements may help.
- You may experience a metallic taste or find that food has no taste at all. You may dislike foods or beverages that you liked before receiving cancer treatment. These symptoms can last for several months or longer after treatment ends.
- Avoid any food that you think smells or tastes bad. If red meat is a problem, eat chicken, turkey, eggs, dairy products and fish without a strong smell. Sometimes cold food has less of an odor.
- Add extra flavor to meat or fish by marinating it in sweet juices, sweet and sour sauce or dressings. Use seasonings like basil, oregano or rosemary to add flavor. Bacon, ham and onion can add flavor to vegetables.
This medication stimulates your immune system. Your immune system can attack normal organs and tissues in your body, leading to serious or life threatening complications. It is important to notify your healthcare provider right away if you develop any of the following symptoms:
- Lung Problems (Pneumonitis): New or worsening cough, shortness of breath, trouble breathing, or chest pain.
- Liver Problems (Hepatitis): Yellowing of the skin or eyes, your urine appears dark or brown, pain in your abdomen, bleeding or bruising more easily than normal, or severe nausea and vomiting.
- Intestinal Problems (Colitis): Abdominal pain, diarrhea, cramping, mucus or blood in the stool, dark or tar-like stools, fever. Diarrhea means different things to different people. Any increase in your normal bowel patterns can be defined as diarrhea and should be reported to your healthcare team.
- Eye problems: blurry or double vision, and changes in vision, eye pain or redness.
- Nerve problems (neuropathy or inflammation of the brain and surrounding tissues): weakness of arms, legs or face, numbness / tingling in the hands or feet, fever, confusion, changes in mood and/or behavior, sensitivity to light, and neck stiffness.
- Infections: Fever, cough, frequent urination, burning with urination, and flu-like symptoms.
- Skin reactions: report rash, with or without itching (pruritis), sores in your mouth, blistering or peeling skin, as these can become severe and require treatment with corticosteroids.
Patients can experience immune-mediated reactions that affect the pituitary, thyroid, pancreas and adrenal glands. These reactions can cause inflammation of these glands and affect their production of certain hormones. Some hormone levels will be monitored with blood work. It is important that you report any changes in how you are feeling to your care team. Symptoms of these hormonal changes can include: headaches, nausea, vomiting, extreme fatigue, weakness, changes in memory and concentration, weight gain, dizziness, feeling cold all the time, changes in mood or behavior (including irritability, forgetfulness and decreased sex drive), feeling more hungry or thirsty or urinating more than usual.
Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment and for at least 5 months after treatment. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should consult with your healthcare team before breastfeeding while receiving this medication.