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Atezolizumab is a humanized IgG1 monoclonal antibody that targets programmed cell death ligand 1 (PD-L1). Atezolizumab has received FDA approval for multiple neoplastic conditions and may be administered as monotherapy or in combination with chemotherapy. Indications include locally advanced or metastatic urothelial carcinoma, metastatic non-small cell lung cancer, extensive-stage small cell lung cancer, metastatic triple-negative breast cancer, and unresectable or metastatic hepatocellular carcinoma. This activity reviews the various pharmacological features of atezolizumab, including the mechanism of action and dosage adjustments. Additionally, warnings, precautions, and monitoring parameters are emphasized to ensure optimal patient outcomes. Adverse events and contraindications are also highlighted to guide clinicians in minimizing risks associated with atezolizumab therapy. Improved care coordination between interprofessional team members is essential to maximize the therapeutic benefits for patients receiving this medication. Objectives: Identify the mechanism of action of atezolizumab. Assess the adverse effects associated with atezolizumab administration. Determine monitoring parameters for immune-mediated adverse reactions encountered during atezolizumab therapy. Determine the importance of an interprofessional team approach and care coordination when treating patients with atezolizumab. Access free multiple choice questions on this topic.

There is no available data regarding the safety of atezolizumab in pediatric patients and pregnant or breastfeeding women.[12][11] There is also no available data about the drug-drug interaction potential of atezolizumab.[13] Immune-mediated colitis Grade 1 colitis should be treated with symptomatic management. Atezolizumab must be held for patients experiencing grade 2 and 3 colitis, and patients should be started on steroids with a slow taper. Atezolizumab should be permanently discontinued for patients experiencing grade 4 colitis. Immune-mediated pneumonitis Tapering corticosteroids is recommended if there is evidence of pneumonitis or interstitial lung disease on lung imaging. Atezolizumab should be held for grade 2 pneumonitis and permanently discontinued if there is evidence of grade 3 or 4 pneumonitis. Immune-mediated hepatitis After ruling out viral hepatitis and other etiologies of elevated liver function tests, atezolizumab must be held for patients experiencing Grade 2 hepatitis. Patients should be started on oral or IV steroids followed by a slow taper. Atezolizumab must be permanently discontinued for patients experiencing Grade 3 and 4 immune-mediated hepatitis; these patients should be started on IV steroids. Immune-mediated endocrinopathies Thyroid disorders If clinically indicated, consider thyroid hormone replacement therapy in hypothyroidism or medical management of hyperthyroidism. Adrenal insufficiency/hypophysitis Consider initiating stress dose corticosteroids and hormone replacement therapy as clinically indicated. Type 1 diabetes Consider starting insulin if indicated. Atezolizumab should be held for patients with grade 2 to 4 endocrinopathies. Immune-mediated renal dysfunction and nephritis Atezolizumab should be held for patients with grade 2 toxicity or higher, and corticosteroid administration should be considered. Immune-mediated cutaneous adverse reactions Topical steroids are indicated for grade 1 or 2 toxicity. Atezolizumab must be held in grade 2 and 3 toxicity; patients with grade 2 toxicity should be treated with oral steroids. Atezolizumab must be permanently discontinued in patients with grade 4 immune toxicity, and patients should be treated with IV steroids in an intensive care unit (ICU).

Given its propensity to cause immune-mediated adverse reactions, the clinical use of atezolizumab requires an interprofessional team approach of healthcare professionals to enhance safety and efficacy. Clinicians prescribing this drug should educate their patients about the immediate and long-term adverse reactions. The clinical pharmacist and the nurse administering the drug infusion to the patients about the mechanism of action, recommended doses, and infusion-related adverse reactions of atezolizumab. Laboratory tests must be performed and reviewed before and during treatment with atezolizumab. This interprofessional approach will yield optimal therapeutic results. There should be close communication between the ordering clinicians, the pharmacist, and the nurse about any infusion-related reactions or laboratory abnormalities related to the drug. Signs and symptoms of immune-mediated adverse reactions during treatment or long after discontinuation of atezolizumab should be monitored, and appropriate clinical investigations must be performed to rule out other etiologies. Detailed prescribing information and essential dose management information specific to adverse reactions should always be available for review. Applicable clinical specialties must be promptly consulted. Such a holistic approach would lead to timely identification and management of this drug's potential adverse effects, resulting in improved outcomes.