Anti-PD-L1 Monoclonal Antibody — Immune Checkpoint Inhibitor (Specialist Oncology Drug)

Atezolizumab

Brand names: Tecentriq

Adult dose

Dose: Refer to BNF, SmPC, and current SACT protocol

Route: Intravenous infusion

Frequency: As per SACT/MDT guidance (typically every 2, 3, or 4 weeks depending on indication)

Clinical pearls

Anti-PD-L1 checkpoint inhibitor — approved for urothelial carcinoma, NSCLC, TNBC (triple-negative breast cancer), hepatocellular carcinoma, and small cell lung cancer (in various combinations and settings)
Multiple NICE TAs across different tumour types — check specific indication for current approval status
irAE management: grade 1 — continue with monitoring; grade 2 — hold, start corticosteroids; grade 3–4 — permanently discontinue and high-dose steroids ± steroid-sparing immunosuppressants
Thyroid function: hypothyroidism managed with levothyroxine while continuing atezolizumab; hyperthyroidism usually self-limiting
PD-L1 expression may predict response in some tumour types (e.g., NSCLC)
Immune-related toxicities can occur months after stopping treatment

Contraindications

Active autoimmune disease requiring systemic immunosuppression (relative — specialist assessment)
See SmPC for specific contraindications

Side effects

Immune-related adverse events (irAE): pneumonitis, colitis, hepatitis, thyroid dysfunction, adrenal insufficiency, nephritis, rash, myositis
Fatigue
Infusion-related reactions
Hypothyroidism or hyperthyroidism

Interactions

Systemic corticosteroids (immunosuppression may reduce efficacy if used prophylactically before irAE development; required for irAE treatment)

Monitoring

Tumour response assessment per SACT protocol (CT every 2–3 cycles)
TFTs (TSH) at baseline and every 6–8 weeks
LFTs, renal function
Blood glucose
Symptoms of irAEs (respiratory, GI, skin, neurological) at each visit
FBC

Reference: BNF; NICE TAs (multiple — check specific tumour type); ESMO Immuno-Oncology Guidelines; ASCO/ESMO irAE management guidelines (2022); https://bnf.nice.org.uk/drugs/atezolizumab/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Avelumab · Anti-PD-L1 Monoclonal Antibody — Immune Checkpoint Inhibitor (Specialist Oncology Drug)

Pathways