Oncology Drug Reference Sheet: Atezolizumab’s Indications for Breast and Lung Cancer

July 23, 2019 by Erin Dickman DNP, RN, OCN®

The U.S. Food and Drug Administration (FDA) first approved atezolizumab (Tecentriq®) in 2016, but it received additional approvals when used in combination treatments for locally advanced or metastatic triple negative breast cancer (TNBC) and small cell lung cancer (SCLC) in March 2019. 

Atezolizumab’s new indication in combination with protein-bound paclitaxel for TNBC in patients who have not received prior chemotherapy for metastatic disease was evaluated in IMpassion130, a multicenter, international, randomized, double-blinded placebo-controlled trial. And its new use with carboplatin and etoposide in the treatment of SCLC was evaluated in IMpower133, a randomized, multicenter, double-blind, placebo-controlled trial.


Immunotherapy/programmed death-ligand 1 (PD-L1) blocking monoclonal antibody (checkpoint inhibitor)

New Indications  

FDA approved two new indication for atezolizumab in March 2019: TNBC and SCLC. It was previously approved for urothelial carcinoma and non-small cell lung cancer. 

TNBC: Atezolizumab is indicated for use in combination with protein-bound paclitaxel for the treatment of adult patients with unresectable locally advanced or metastatic TNBC whose tumors express PD-L1 (PD-L1 stained tumor-infiltrating immune cells of any intensity covering at least 1% of the tumor area), as determined by an FDA-approved test. The indication was given accelerated approval based on progression-free survival.  

SCLC: Atezolizumab is indicated for use in combination with carboplatin and etoposide for the first-line treatment of adult patients with extensive-stage SCLC. 

Dosing and Administration

TNBC: 840 mg via IV over 60 minutes, followed by 100 mg/m2 protein-bound paclitaxel. For each 28-day cycle, atezolizumab is administered on days 1 and 15 and protein-bound paclitaxel is administered on days 1, 8, and 15.  

SCLC: 1,200 mg IV over 60 minutes every three weeks. Administer atezolizumab prior to chemotherapy when given the same day.  

Additional administration instructions: 

Adverse Reactions  

The following reactions are for the combination treatments with the two new indications. Additional adverse reactions when used as a single agent can be found in the package insert (https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/761034s019lbl.pdf).  

TNBC: The most common adverse reactions (reported in at least 20% of patients) with atezoluzimab in combination with protein-bound paclitaxel are alopecia, peripheral neuropathies, fatigue, nausea, diarrhea, anemia, constipation, cough, headache, neutropenia, vomiting, and decreased appetite.  

SCLC: Most common adverse reactions (reported in at least 20% of patients) with atezoluzimab in combination with other antineoplastic drugs are fatigue/asthenia, nausea, alopecia, constipation, diarrhea, and decreased appetite.    

Nursing Considerations 

Monitor for immune-mediated adverse effects, including pneumonitis, hepatitis, colitis, and endocrinopathies (hypophysitis, changes in thyroid function, adrenal insufficiency, and hyperglycemia). Additionally, monitor for infection. The therapy may need to be withheld or discontinued permanently based on the severity of adverse effects.  

Infusion reaction can occur, and infusion should be interrupted, slowed, or permanently discontinued based on the severity of the reaction (see package insert (https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/761034s019lbl.pdf) for dosage modifications).  

Atezolizumab can cause fetal harm; advise women of reproductive potential of the possible risk to a fetus and to use effective contraception during treatment and five months following the last dose. Women of childbearing potential should have a pregnancy test before beginning treatment. In addition, women receiving atezolizumab should not breastfeed their children during treatment and for five months after their last dose.  

Drug-Drug and Drug-Food Interactions   

The drug interaction potential of atezolizumab is unknown.    

Patient Education   

Gero-Onoclogy Considerations    

No overall differences in safety or effectiveness were observed between patients aged 65 years or older and younger patients. 

Safe Handling     

Atezolizumab is considered a hazardous drug because it can cause embryo-fetal toxicity and may impair fertility in females of reproductive potential.   

Patient Assistance Programs       

Patient assistance may be available at Tecentriq's® website (https://www.tecentriq.com/urothelial-carcinoma/patient-support/sign-up.html)

Copyright © 2019 by the Oncology Nursing Society. User has permission to print one copy for personal or unit-based educational use. Contact pubpermissions@ons.org for quantity reprints or permission to adapt, excerpt, post online, or reuse ONS Voice content for any other purpose.