Is atezolizumab (Tecentriq) a chemotherapy or immunotherapy drug?

Key Points

Atezolizumab (brand name: Tecentriq) is a type of immunotherapy drug called an “immune checkpoint inhibitor”. It helps to stimulate the body’s immune system to fight cancer.

One way that cancer cells hide from the immune system is to take control of regulatory pathways like the "checkpoint" inhibitor pathway. Tecentriq can help to block this process to fight off cancer.

Atezolizumab works by targeting and blocking a protein called PD-L1 on the surface of certain immune cells called T-cells. Blocking PD-L1 triggers the T-cells to find and kill the cancer cells.

Tecentriq, from Genentech, was first approved in May 2016 and is used to treat advanced forms of:

• melanoma (skin cancer)
• non-small cell lung cancer (NSCLC)
• small cell lung cancer (SCLC)
• liver cancer
• alveolar soft part sarcoma (ASPS), a rare soft tissue tumor

Which U.S. indications have been withdrawn for Tecentriq?

The uses that have been withdrawn for Tecentriq and removed from the U.S. prescribing information include metastatic urothelial carcinoma (mUC, bladder cancer) and triple-negative breast cancer.

• In December 2022, Genentech voluntarily withdrew the U.S. accelerated approval for Tecentriq in locally advanced or metastatic urothelial carcinoma (mUC, bladder cancer) in patients who are not eligible for cisplatin-containing chemotherapy. Urothelial carcinoma develops in the cells of the bladder lining. Results from the IMvigor130 study did not meet the endpoint of overall survival (OS) for Tecentriq plus chemotherapy compared with chemotherapy alone.
• In March 2021, Genentech voluntarily withdrew the U.S. accelerated approval for Tecentriq in prior-platinum treated metastatic urothelial carcinoma (mUC, bladder cancer). Results from the IMvigor211 study did not meet its primary endpoint of overall survival in the PD-L1 high patient population.
• In August 2021, Genentech voluntarily withdrew the U.S. accelerated approval for Tecentriq in combination with albumin-bound paclitaxel for adults with triple-negative breast cancer (mTNBC). This is not related to any changes in either the effectiveness or safety associated with Tecentriq.

What is the difference between chemotherapy and immunotherapy?

Our own body has ways to fight off foreign substances and cancers through our immune system. However, cancer can learn how to hide from our immune system and can bypass inactivation that our own body usually provides. When this happens, cancer can grow.

Chemotherapy (“chemo”) kills rapidly dividing cancer cells and acts on cancer cells directly. Chemotherapy can be used with other treatments, such as surgery, radiation or immunotherapy, for an overall treatment regimen.

Immunotherapy helps to boost your natural immune system to fight off diseases such as cancer. Immunotherapy works by:

• Stimulating your immune system so it works better to find and attack cancer cells.
• Improving your immune system’s ability to fight off cancer by giving you substances made in lab that are like your natural immune system cells
• However, immunotherapy can also target normal cell organs cells in your body which may lead to serious side effects, but in general, immunotherapy may be better tolerated than many of the older standard cancer treatments.

Immunotherapy can be given alone or in combination with other types of cancer treatments. It is given by an intravenous (IV) injection into your vein.

Immunotherapy is now an established way of administering cancer treatments and has shown success in many different types of malignancies.

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Which checkpoint inhibitors are approved by the FDA?

There are several immune checkpoint inhibitors approved by the FDA, and they treat many different types of cancers. The available checkpoint inhibitors include:

• Bavencio (avelumab)
• Imfinzi (durvalumab)
• Jemperli (dostarlimab-gxly)
• Keytruda (pembrolizumab)
• Libtayo (cemiplimab-rwlc)
• Opdivo (nivolumab)
• Tecentriq (atezolizumab)
• Yervoy (ipilimumab)

How does atezolizumab (Tecentriq) work?

How atezolizumab (Tecentriq) works is somewhat different than with PD-1 checkpoint inhibitors.

• PD-L1 is a ligand on the tumor for the checkpoint PD-1 on the T-cell. Ligands interact with receptors.
• The interaction between PD-L1 ligand on the tumor and PD-1 receptor on the T-cell leads to T-cell inactivation and blocks the natural anti-tumor immune response. Due to this interaction, the tumor is not effectively attacked or killed.
• However, Tecentriq binds to the PD-L1 (ligand) site on the tumor and blocks the PD-1 interaction on the T cell, which allows the anti-tumor immune response to be triggered.

Tecentriq was the first FDA-approved PD-L1 inhibitor.

What serious side effects can occur with atezolizumab?

Atezolizumab (Tecentriq) can cause your immune system to attack normal organs and tissues in any area of your body and can affect the way they work. These problems can sometimes become serious or life-threatening and can lead to death. These problems, called immune-mediated side effects, might happen anytime during or after your treatment.

Examples of immune-mediated side effects with Tecentriq, which can be fatal, include:

• pneumonitis (lung inflammation)
• hepatitis (inflammatory condition of the liver)
• colitis (inflammation of the inner lining of the colon), diarrhea
• endocrinopathies (may include thyroid disorders, adrenal insufficiency, and type 1 diabetes)

Tecentriq may also increase the risk for infections, which may be serious.

In addition to immune-mediated side effects, the most common side effects reported in clinical trials included:

• fatigue
• decreased appetite
• nausea
• urinary tract infections
• fever
• constipation.

Related: See a full listing of atezolizumab (Tecentriq) side effects here.

Bottom Line

• Atezolizumab (brand name: Tecentriq) is a type of immunotherapy drug called an “immune checkpoint inhibitor”. It helps to stimulate the body’s immune system to fight cancer.
• Atezolizumab works by targeting and blocking a protein called PD-L1 on the surface of the tumor. Blocking PD-L1 triggers the T-cells to find and kill the cancer cells.
• Tecentriq is FDA-approved to treat several cancers, including advanced forms of skin cancer (melanoma), liver cancer, and lung cancer.

This is not all the information you need to know about atezolizumab (Tecentriq) for safe and effective use and does not replace your healthcare provider's instructions. Review the full Tecentriq information here, and discuss this information and any questions with your doctor or other health care provider.