Atezolizumab (Tecentriq)
Drug class: Immune checkpoint inhibitors (PD-L1 inhibitor)
Mechanism of Action
Atezolizumab is a humanized monoclonal antibody that blocks programmed death ligand 1 (PD L1). Normally, PD L1 binds to tumour-specific T cell receptors, suppressing immune activity and preventing tumour destruction (1,2).
As an immune checkpoint inhibitor, atezolizumab reactivates the immune response by binding PD-L1 on cancer cell surfaces, promoting tumour cell elimination. It is approved for multiple cancer types and was the first immunotherapy authorised as a first line (1L) option across several indications (3).
Approved Indications
Alveolar soft part sarcoma (ASPS)
Hepatocellular carcinoma (HCC)
Melanoma
Muscle-invasive bladder cancer (MIBC)
Non-small cell lung cancer (NSCLC)
Small Cell Lung Cancer (SCLC)
Dosage and Administration
Intravenously (1)
840 mg every 2 weeks or
1200 mg every 3 weeks or
1680 mg every 4 weeks
Key clinical benefits
Reactivate the immune system, promoting anti-tumour activity (2)
Improved survival rates in Extensive-Stage Small Cell Lung Cancer (ES-SCLC) and Advanced or metastatic Non-Small Cell Lung Cancer (mNSCLC) (1)
Reduced risk of cancer recurrence or death (4)
Available as a subcutaneous injection (Tecentriq Hybreza) (4, 5)
Effective 1L treatment option as combination therapy against unresectable liver cancer (1)
Key clinical trials
IMpower110 Trial - Phase 3 Trial in mNSCLC
In a randomized, open label, phase 3 trial involving 572 patients with metastatic non small cell lung cancer (mNSCLC) and PD L1 expression, the efficacy and safety of atezolizumab as first line therapy were compared with platinum based chemotherapy. The primary endpoint, overall survival (OS), showed a significant benefit in patients with EGFR/ALK wild type tumours and the highest PD L1 expression, with atezolizumab extending OS by 7.1 months compared to chemotherapy (20.2 vs 13.1 months; HR 0.59; 95% CI 0.40–0.89; p=0.01). No significant OS difference was observed in patients with high or intermediate PD L1 expression. Adverse events occurred in 90.2% of patients receiving atezolizumab and 94.7% of those receiving chemotherapy, while grade 3–4 adverse events were lower in the atezolizumab group (30.1%) than in the chemotherapy group (52.5%) (3).
IMpower010 - open label phase III study
This global, open label phase III study was the first to evaluate survival outcomes with a five year follow up in resected stage IB–IIIA non small cell lung cancer (NSCLC). A total of 990 patients were randomized to receive atezolizumab (1,200 mg every three weeks for 16 cycles) or best supportive care (BSC). In the intention to treat population, atezolizumab demonstrated a hazard ratio (HR) for disease free survival (DFS) of 0.85 (95% CI, 0.71–1.01; p=0.07). Among all randomized stage II–IIIA patients, the HR was 0.83 (95% CI, 0.69–1.00), while in stage II–IIIA patients with PD L1 tumour cell (TC) ≥1%, the HR was 0.70 (95% CI, 0.55–0.91). Atezolizumab provided DFS and overall survival (OS) benefit compared with BSC following adjuvant chemotherapy in stage II–IIIA patients with PD L1 TC ≥1% and PD L1 TC ≥50%, irrespective of EGFR/ALK mutation status. Immune related adverse events were reported in both treatment groups (6).
IMVigor011 study - double blind, phase III trial in patients with MIBC
The IMvigor011 study was a global, double blind, phase III trial that randomised adult patients with muscle-invasive bladder cancer (MIBC) who had circulating tumour DNA molecular residual disease (ctDNA MRD) following cystectomy. The trial evaluated the efficacy and safety of adjuvant atezolizumab compared with placebo. Results showed that atezolizumab improved disease-free survival (DFS) by 36% and overall survival (OS) by 41% in patients with detectable ctDNA MRD after one year, indicating a significant survival benefit in MIBC after cystectomy. Importantly, atezolizumab became the first FDA approved agent for adjuvant treatment of MIBC with ctDNA MRD following cystectomy (4, 7).
Common Adverse Events
As a single agent
Asthenia/fatigue (1)
Cough (1)
Decreased appetite (1)
Dyspnea (1)
Nausea (1)
With other antineoplastic drugs (NSCLC and SCLC)
Alopecia (1)
Asthenia/fatigue (1)
Nausea (1)
Constipation (1)
Diarrhea (1)
Decreased appetite (1)
With bevacizumab (HCC)
Hypertension (1)
Fatigue (1)
Proteinuria (1)
With cobimetinib and vemurafenib (Melanoma) (1)
Rash (1)
Musculoskeletal pain (1)
Fatigue (1)
Hepatotoxicity (1)
Pyrexia (1)
Nausea (1)
Pruritus (1)
Edema (1)
Stomatitis (1)
Hypothyroidism (1)
Photosensitivity reaction (1)
Contraindications
Atezolizumab has no formal contraindications listed in its FDA prescribing information. However, clinicians must exercise caution due to serious immune mediated risks, infusion reactions, and embryo fetal toxicity (1).
Special Notes for Clinician
Patient Selection: Confirm PD L1 expression status where indicated; assess EGFR/ALK mutation status in NSCLC before use.
Screening: Rule out active infections, including tuberculosis, prior to initiation.
Monitoring: Watch for immune mediated toxicities (pneumonitis, hepatitis, colitis, endocrinopathies, nephritis, dermatologic reactions).
Infusion Reactions: Monitor during and after infusion; interrupt or discontinue if severe.
Immunizations: Avoid live vaccines during treatment.
Pregnancy: Counsel on embryo fetal toxicity risk; advise effective contraception during therapy and for at least 5 months after the last dose.
Transplant Patients: Be cautious—risk of organ transplant rejection or complications post stem cell transplant.
Discontinuation: Stop treatment promptly if severe immune related adverse events or hypersensitivity occur.
Abbreviations
PD-1: programmed death ligand 1; mAb: monoclonal antibody; 1L: first-line; ASPS: alveolar soft part sarcoma; HCC: hepatocellular carcinoma; MIBC: muscle-invasive bladder cancer; NSCLC: non-small cell lung cancer; SCLC: small cell lung cancer; ES-SLC: extensive-stage small cell lung cancer; mNSCLC: advanced or metastatic non-small cell lung cancer, OS: overall survival; EGFR: Epidermal Growth Factor Receptor; ALK: Anaplastic Lymphoma Kinase; CI: confidence interval; DFS: disease free survival; BSC: best supportive care; ctDNA MRD: circulating tumor DNA molecular residual disease.
References
Atezolizumab prescribing information. Available at:https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/761034s043lbl.pdf Accessed on 16 September 2026
Ai L, Chen J, Yan H, et al. Research Status and Outlook of PD-1/PD-L1 Inhibitors for Cancer Therapy. Drug Des Devel Ther. 2020; 14:3625-3649.
Herbst RS, Giaccone G, de Marinis F et al. Atezolizumab for first-line treatment of PD-L1–selected patients with NSCLC. N Engl J Med. 2020; 383(14):1328-39.
FDA Approves Genentech’s Tecentriq for Adjuvant Muscle-Invasive Bladder Cancer With ctDNA-Guided Treatment. Available at: https://www.gene.com/media/press-releases/15112/2026-05-15/fda-approves-genentechs-tecentriq-for-ad Accessed on 16 September 2026.
FDA approves Roche’s Tecentriq Hybreza, the first and only subcutaneous anti-PD-(L)1 cancer immunotherapy. https://www.roche.com/media/releases/med-cor-2024-09-13 Accessed on 16 September 2026
Felip E, Altorki N, Zhou C, Vallières E. Five-year survival outcomes with atezolizumab after chemotherapy in resected stage IB-IIIA non–small cell lung cancer (IMpower010): an open-label, randomized, phase III trial. J Clin Oncol. 2025; 43(21):2343-9.
Jackson-Spence F, Toms C, O’Mahony LF, et al. IMvigor011: a study of adjuvant atezolizumab in patients with high-risk MIBC who are ctDNA+ post-surgery. Fut Oncol. 2023;19(7):509-15.
About the Author
Jaimee George holds a PhD in Microbiology and has published extensively in peer reviewed journals. As a scientific writer, she has developed systematic reviews, book chapters, review articles, and original research papers. Her professional interests include regulatory writing, medical communication tools, and case report development.
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