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Atezolizumab (Tecentriq) instructions
Common name: Atezolizumab
Trade name: Tecentriq
All names: Atezolizumab, Tecentriq, T drug, Tecentriq, Atezolizumab
Indications
Atezolizumab The indications for anti-cancer are very similar to nivolumab. According to the latest NCCN guidelines, the recommended medication for atezolizumab is as follows:
First-line medication:
1. Non-small cell lung cancer with negative or unknown EFGR gene, ALK, and ROS1 rearrangement, PD-1 expression (PD-1 ≥ 1%), and PS (physical activity status) score 0-2.
2. Atezolizumab combined with bevacizumab and chemotherapy is a first-line treatment for metastatic non-squamous non-small cell lung cancer without EGFR or ALK mutations.
3. In 2019, the US FDA approved atezolizumab combined with carboplatin and etoposide for the first-line treatment of extensive-stage small cell lung cancer (SCLC).
4. Atezolizumab can be combined with nab-paclitaxel for first-line treatment of unresectable locally advanced or metastatic PD-L1-positive triple-negative breast cancer.
Second-line treatment:
(1) Metastatic non-small cell lung cancer with disease progression after platinum-containing chemotherapy regimen.
(2) Non-small cell lung cancer in patients carrying EGFR or ALK tumor gene mutations who still develop disease progression after receiving FDA-approved therapies.
There is no need to evaluate PD-L1 expression levels when using second-line drugs. Trial data prove that atezolizumab can be effective in patients with different expression levels of PD-L1.
On April 17, 2017, the FDA accelerated approval of atezolizumab for the initial treatment of patients with advanced bladder cancer who cannot be treated with cisplatin.
On May 18, 2016, the FDA approved atezolizumab for the treatment of urothelial cancer (the most common type of bladder cancer) that is resistant to or has progressed after adjuvant or neoadjuvant platinum-based chemotherapy.
Usage and Dosage
At present, Atezolizumab Tecentriq has only one specification: 20 mL injection in a single-dose vial, and each bottle of solution contains Atezolizumab Tecentriq 1200 mg.
Recommended dosage
Intravenous infusion of 1200mg once every 3 weeks, with an infusion time of 60 minutes. Dilute with 250ml of 0.9% sodium chloride injection before intravenous infusion.
It is not recommended to reduce the dosage and store it for more than 24 hours after opening. Store refrigerated at 2-8°C before preparation. It is recommended to use it immediately after preparation.
Recommended dose for non-small cell lung cancer (NSCLC): 1200 mg each time, intravenously administered once every 3 weeks, over 60 minutes each time. If used in combination, administer atezolizumab first on the same day as chemotherapy or other antineoplastic agents.
Recommended dose for urothelial cancer: 1200 mg intravenously over 60 minutes, once every 3 weeks until disease progression or intolerable toxicity.
Adjust dose due to adverse reactions
For symptomatic adverse drug reactions (such as severe/persistent diarrhea or skin-related adverse reactions), they can be controlled by interrupting treatment and reducing the dose of this product.
Adverse Reactions
The most common adverse reactions (≥ 20% of patients) include: fatigue, decreased appetite, nausea, urinary tract infection, pyrexia and constipation.
Drugs for pregnant and lactating women:
Breastfeeding: It is advised not to breastfeed.
2. Atezolizumab + bevacizumab combined with carboplatin + paclitaxel in the first-line treatment of advanced non-squamous NSCLC: Compared with the combination of bevacizumab + carboplatin + paclitaxel, the four-drug combination can reduce the patient's risk of disease recurrence by 38%. The progression-free survival (PFS) benefit can be observed in patients with different PD-L1 expression levels, and no new safety issues have been found.
Mechanism of action
Atezolizumab (T drug) plays an anti-cancer effect by blocking a PD-1/PD-L1 signaling pathway. PD-1 is a marker expressed on the cell membrane of the body's immune T cells. The ligand that can bind to it is PD-L1. Once they combine, they will send a signal to T cells that "the immunity is now strong enough and there is no need to work anymore", causing T cells to enter a dormant state to prevent the body from developing autoimmunity.
Tumor cells take advantage of such a loophole and "confuse" immune cells through their high expression of PD-L1, causing them to lose their normal ability to recognize and kill tumors. Atezolizumab blocks the source of negative regulation by binding to PD-L1 on tumor cells and tumor-infiltrating immune cells, thereby comprehensively reactivating T cell functions and killing cancer cells.