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Tecentriq
atezolizumab
Adult Dosing .
Dosage forms: INJ
Special Note
- [equivalency or interchangeability info]
- Info: not interchangeable w/ SC atezolizumab/hyaluronidase; do not substitute on a mg to mg basis
- [uses, dosing may vary]
- Info: refer to institution protocols and pkg insert prior to prescribing for uses and dosing incl. toxicity-related dose adjustments
non-small cell lung CA
- [stage II-IIIA PD-L1-expressing disease, adjuvant tx]
- Dose: 1680 mg IV q4wk for up to 1y; Start: after resection and platinum-based chemo; Alt: 1200 mg IV q3wk for up to 1y or 840 mg IV q2wk for up to 1y
- [metastatic high PD-L1-expressing disease, first-line tx]
- Dose: 1680 mg IV q4wk; Alt: 1200 mg IV q3wk or 840 mg IV q2wk; Info: for patients w/ no EGFR or ALK genomic tumor aberrations
- [metastatic nonsquamous disease, first-line tx]
- Dose: 1680 mg IV q4wk; Alt: 1200 mg IV q3wk or 840 mg IV q2wk; Info: for patients w/ no EGFR or ALK genomic tumor aberrations; part of multi-drug chemo regimen
- [metastatic progressive disease]
- Dose: 1680 mg IV q4wk; Alt: 1200 mg IV q3wk or 840 mg IV q2wk; Info: for patients w/ disease progression on or after platinum-containing chemo
small cell lung CA, extensive stage
- [first-line induction tx]
- Dose: 1680 mg IV q4wk; Alt: 1200 mg IV q3wk or 840 mg IV q2wk; Info: part of multi-drug chemo regimen
- [maintenance tx]
- Dose: 1680 mg IV q4wk; Alt: 1200 mg IV q3wk or 840 mg IV q2wk; Info: for patients w/o disease progression after first-line induction tx; use w/ lurbinectedin
hepatocellular CA, unresectable or metastatic
- [1680 mg IV q4wk]
- Alt: 1200 mg IV q3wk or 840 mg IV q2wk; Info: use w/ bevacizumab
melanoma, unresectable or metastatic
- [1680 mg IV q4wk]
- Start: after one 28-day cycle of cobimetinib and vemurafenib; Alt: 1200 mg IV q3wk or 840 mg IV q2wk; Info: for patients w/ BRAF V600 mutation; use w/ cobimetinib and vemurafenib
alveolar soft part sarcoma, unresectable or metastatic
- [1680 mg IV q4wk]
- Alt: 1200 mg IV q3wk or 840 mg IV q2wk
urothelial carcinoma, locally advanced or metastatic
- [indication withdrawn in US]
- Info: drug not shown to improve overall survival in cisplatin-ineligible patients w/ PD-L1-expressing tumor or platinum-ineligible patients regardless of PD-L1 status
renal dosing
- [see below]
- eGFR >30: no adjustment; eGFR <30: not defined
- HD/PD: not defined
hepatic dosing
- [see below]
- mild-moderate impairment: no adjustment; severe impairment: not defined
Peds Dosing .
- Dosage forms: INJ
Special Note
- [equivalency or interchangeability info]
- Info: not interchangeable w/ SC atezolizumab/hyaluronidase; do not substitute on a mg to mg basis
- [uses, dosing may vary]
- Info: refer to institution protocols and pkg insert prior to prescribing for uses and dosing incl. toxicity-related dose adjustments
alveolar soft part sarcoma, unresectable or metastatic
- [2 yo and older]
- Dose: 15 mg/kg/dose IV q3wk; Max: 1200 mg/dose
renal dosing
- [see below]
- eGFR >30: no adjustment; eGFR <30: not defined
- HD/PD: not defined
hepatic dosing
- [see below]
- mild-moderate impairment: no adjustment; severe impairment: not defined
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- avoid: breastfeeding during tx and for at least 5mo after D/C
- caution: patients of childbearing potential
- caution: transplant history
- caution: transplant candidates
- caution: thoracic XRT history
Drug Interactions .
Overview
atezolizumab
PD-L1 blocking antibody
- immunomodulatory effects
Contraindicated
- adenovirus vaccine, live
- chikungunya vaccine, live
- cholera vaccine, live
- dengue vaccine, live
- influenza nasal vaccine, live
- measles/mumps/rubella vaccine, live
- rotavirus vaccine, live
- smallpox vaccine, live
- typhoid vaccine, live
- varicella vaccine, live
- yellow fever vaccine, live
Monitor/Modify Tx
- anthrax vaccine
- chikungunya vaccine
- COVID-19 vaccine
- diphtheria/tetanus vaccine
- diphtheria/tetanus/pertussis vaccine
- ebola vaccine, live
- Haemophilus b vaccine
- hepatitis A vaccine
- hepatitis B vaccine
- human papillomavirus vaccine
- influenza H5N1 vaccine
- influenza vaccine
- Japanese encephalitis vaccine
- meningococcal vaccine
- pneumococcal vaccine
- poliovirus vaccine
- rabies vaccine
- respiratory syncytial virus vaccine
- smallpox/mpox vaccine, live
- tick-borne encephalitis vaccine
- typhoid vaccine
Adverse Reactions .
Serious Reactions
- immune-mediated reaction
- pneumonitis
- interstitial lung disease
- pleural effusion
- dyspnea
- pulmonary embolism
- hepatitis
- colitis
- endocrinopathy
- adrenal insufficiency
- hypophysitis
- thyroiditis
- hypothyroidism
- hyperthyroidism
- hypoparathyroidism
- diabetes mellitus, type 1
- hypopituitarism
- nephritis
- pancreatitis
- meningitis
- encephalitis
- demyelination
- myasthenia gravis
- Guillain-Barre syndrome
- nerve paresis
- autoimmune neuropathy
- myositis
- rhabdomyolysis
- myocarditis
- pericarditis
- vasculitis
- cardiac tamponade
- arrhythmia
- uveitis
- Vogt-Koyanagi-Harada-like syndrome
- Stevens-Johnson syndrome
- toxic epidermal necrolysis
- drug reaction w/ eosinophilia and systemic symptoms
- hemolytic anemia
- aplastic anemia
- hemophagocytic lymphohistiocytosis
- immune thrombocytopenic purpura
- hemorrhage
- infection, severe
- sepsis
- infusion reaction, severe
- anaphylaxis
Common Reactions
- fatigue
- cough
- fever
- appetite decr.
- dyspnea
- rash
- nausea
- constipation
- diarrhea
- pain
- arthralgia
- pruritus
- hypothyroidism
- peripheral neuropathy
- pneumonitis
- hepatitis
- anemia
- ALT or AST incr.
- hypoalbuminemia
- hyponatremia
- alk phos incr.
- Cr incr.
- lymphopenia
Safety/Monitoring .
Monitoring Parameters
pregnancy test at baseline; Cr, LFTs, TFTs at baseline, then periodically; glucose; signs/symptoms of infusion reaction
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; no human data available; risk of embryo-fetal toxicity, incl. spontaneous abortion and stillbirth, based on animal data w/ other PD-1/PD-L1 pathway inhibitors and drug's mechanism of action
Individuals of Reproductive Potential
obtain pregnancy test before tx start; avoid pregnancy by using effective contraception during tx and for at least 5mo after D/C in patients of childbearing potential
Lactation
Clinical Summary
avoid breastfeeding during tx and for at least 5mo after D/C; no human data available to assess risk of infant harm or effects on milk production
Pharmacology .
Metabolism: catabolism; CYP450: unknown
Excretion: other; Half-life: 27 days
Subclass: Immunotherapy, Immune Checkpoint Inhibitors ; Immunotherapy, PD-1/PD-L1 Inhibitors
Mechanism of Action
binds to PD-L1 on tumor cells and tumor-infiltrating immune cells, blocking PD-1/PD-L1 pathway-mediated inhibition of anti-tumor immune response, resulting in decreased tumor growth (monoclonal antibody)
Formulary .
No Formulary Selected
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