Atezolizumab is a type of immunotherapy drug. 

It's a treatment for some people who have:

• cancer of the bladder or urinary system (called urothelial or transitional cell carcinoma)
• non small cell lung cancer (NSCLC)

You usually only have atezolizumab after you've had chemotherapy or if you're not able to have chemotherapy.

You may have atezolizumab on its own or you might have it in combination with other drugs.

How atezolizumab works

Atezolizumab works by blocking a protein that stops the immune system from working properly and attacking cancer cells. It helps to make your immune system find and kill cancer cells. 

How you have atezolizumab

You have atezolizumab as a drip into your bloodstream (intravenously).

The first time you have atezolizumab, you have it over an hour. If you don’t have a reaction to it you have your next infusions over 30 minutes.

Into your bloodstream

You have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

When you have atezolizumab

You usually have atezolizumab once every 3 weeks. 

You might have atezolizumab for up to 2 years as long as it is working and the side effects aren't too bad.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

We haven't listed all the side effects. It is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatment you are having. For example, your side effects could be worse if you are also having other drugs or radiotherapy.

When to contact your team

Your doctor or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects
• your side effects aren’t getting any better
• your side effects are getting worse

Early treatment can help manage side effects better. 

Common side effects

These side effects happen in more than 10 in 100 people (10%). You might have one or more of them. They include:

High temperature (fever)

If you get a high temperature, let your treatment team know straight away. Ask them if you can take paracetamol to help lower your temperature.

Loss of appetite

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Difficulty breathing

You may have difficulty breathing with wheezing and coughing. Let your doctor or nurse know straight away if this happens. 

Fatigue

Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Diarrhoea and inflamed bowel

Tell your doctor or nurse if you have diarrhoea. Your doctor might give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty of liquid to replace the fluid lost.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques, can all help.

Skin changes

You might notice skin changes, such as dryness, itching and rashes similar to acne on your face, neck and trunk. 

Tell your doctor if you have any rashes or itching. Don't go swimming if you have a rash because the chlorine in the water can make it worse.

If your skin gets dry or itchy, using unperfumed moisturising cream may help. Check with your doctor or nurse before using any creams or lotions. Wear a high factor sun block if you’re going out in the sun.

Joint or back pain

You might feel some pain in your back or joints. Speak to your doctor or nurse about what painkillers you can take to help with this.

Urinary tract infections (UTIs)

Tell your doctor or nurse if you think you might have a bladder infection. You might find it difficult to pass urine, want to go with some urgency or are going more often. There may be pain or burning when you go. You may see blood in your urine, or your urine might smell bad or look cloudy.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (1 to 10%). You might have one or more of them. They include:

• changes in your blood tests showing low levels of potassium and sodium
• low blood pressure
• inflammation of your liver or lungs
• changes to the way your thyroid gland works – it may make too much or not enough thyroid hormone. You may have regular blood tests to check this
• flu-like symptoms
• allergic reaction to the drug that can cause a rash, shortness of breath, redness or swelling of the face and dizziness
• your nose may feel blocked (nasal congestion)
• difficulty in swallowing
• pain in your tummy (abdomen)
• low platelets which means you may bruise and bleed easily
• pain in your muscles or bones (musculoskeletal pain)

Rare side effects

These side effects happen in fewer than 1 in 100 people (1%). You might have one or more of them. They include:

• inflammation of your pancreas - you might not have any symptoms but changes may be picked up on a blood test
• changes in blood sugar levels (diabetes)
• your adrenal glands not making enough important hormones (cortisol and aldosterone)
• inflammation of the heart or brain
• muscle weakness or numbness – go to A&E if you have any numbness or are unable to move

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Pregnancy and contraception

This drug may harm a baby developing in the womb. It is important not to become pregnant while you are having treatment and for 5 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

Don’t breastfeed during this treatment because the drug may come through into your breast milk.

Fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

• have other vaccines, but they might not give you as much protection as usual
• have the flu vaccine (as an injection)
• be in contact with other people who have had live vaccines as injections

Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as oral polio or the typhoid vaccine.

This also includes the rotavirus vaccine given to babies. The virus is in the baby’s poo for up to 2 weeks and could make you ill. So avoid changing their nappies for 2 weeks after their vaccination if possible. Or wear disposable gloves and wash your hands well afterwards.

You should also avoid close contact with children who have had the flu vaccine nasal spray if your immune system is severely weakened. 

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.