Atezolizumab

Immune checkpoint inhibitors
Immune checkpoint inhibitors
High alert
An error with this medicine can cause serious harm: double checks and protocols are used.

An anti-PD-L1 antibody for lung cancer (including small cell), liver cancer with bevacizumab, and melanoma; adverse effects are immune-related.

Updated Nov 1, 2026

Also called: anti-PD-L1 antibody

Quick facts

Group: Immune checkpoint inhibitors
Target: Programmed death-ligand 1 (PD-L1) on tumour and immune cells
Used for: Non-small cell lung cancer · BRAF V600-mutant melanoma
Key effects: Fatigue · Rash and itching · Diarrhoea
Monitor: Thyroid function · Glucose · Stool frequency
ATC: L01FF05

No doses: the clinician sets them by the current guideline.

Mechanism of action

Programmed death-ligand 1 (PD-L1) on tumour and immune cellsAtezolizumab

The crystal shows human PD-L1 bound by the atezolizumab antibody fragment, which covers the surface PD-L1 uses to bind PD-1.

Target in 3D: Programmed death-ligand 1 (PD-L1) on tumour and immune cells. PDB structure 5X8L (RCSB PDB, public domain). View the structure at RCSB PDB

Atezolizumab binds PD-L1, the ligand that tumour cells and some immune cells display, and prevents it from engaging PD-1 on T cells. The brake on T cells inside the tumour is released and tumour cells can be attacked. It acts on the ligand side, while pembrolizumab, nivolumab and cemiplimab act on the receptor side.

Tumour cells display PD-L1
Atezolizumab binds PD-L1
PD-L1 can no longer switch off PD-1-positive T cells
T cells attack the tumour

Indications

Non-small cell lung cancer, alone or with chemotherapy, and extensive small cell lung cancer with carboplatin and etoposide. Lung cancer →
Unresectable hepatocellular carcinoma, with bevacizumab. Hepatocellular carcinoma →
BRAF V600-mutant melanoma, with cobimetinib and vemurafenib. Melanoma →
Alveolar soft part sarcoma. Soft tissue sarcomas (liposarcoma, leiomyosarcoma, rhabdomyosarcoma) →

Adverse effects

Common

Fatigue
Rash and itching
Diarrhoea, nausea, decreased appetite
Cough and breathlessness
Muscle and joint pain
Thyroid dysfunction

Contraindications

Previous severe immune-mediated reaction to a checkpoint inhibitor (generally not re-exposed)
Caution: active autoimmune disease, organ or allogeneic stem-cell transplant

Key interactions

Systemic corticosteroids and other immunosuppressants: Used to treat moderate to severe immune-mediated reactions; they damp the immune response.
Bevacizumab (in liver cancer): Given together; the bevacizumab risks (bleeding, hypertension, perforation) add to the immune ones.

What is monitored

Thyroid function (TSH) before starting and regularly
Liver tests and creatinine before each dose
Glucose; cortisol if fatigue or low blood pressure
Stool frequency, cough and breathlessness at each visit
Signs of myocarditis (chest pain, palpitations) and muscle weakness

Administration and safety

Intravenous infusion only, never as a push or bolus, through a line as the product instructions specify.
Look-alike names: the -mab checkpoint inhibitors (nivolumab, pembrolizumab, atezolizumab, cemiplimab, ipilimumab) are checked by full name; products combined with hyaluronidase for subcutaneous use are not interchangeable with the intravenous ones.
Watch for infusion reactions (chills, fever, rash, breathlessness) during the infusion.

Pregnancy and breastfeeding

Blocking PD-1/PD-L1 or CTLA-4 can harm the fetus (IgG antibodies cross the placenta); effective contraception is used during treatment and for months after, and breastfeeding is avoided.

Nursing care

Before each dose, ask about diarrhoea, cough, rash, headache, fatigue, dizziness, thirst or passing more urine, and review thyroid, liver, kidney and glucose results.
Teach the patient that side effects can start weeks or months after a dose, even after treatment ends, and must be reported early.
Teaching: report diarrhoea or blood in the stool, new cough or breathlessness, yellow skin, severe headache, extreme tiredness, chest pain or muscle weakness at once.
Make sure the patient carries information that they receive immunotherapy, for any emergency visit.

Pharmacokinetics

Absorption: Intravenous infusion (a subcutaneous form with hyaluronidase also exists).
Elimination: Broken down like natural IgG.

Test yourself

Think of the answer, then tap the question to see it.

How does atezolizumab differ from pembrolizumab in its target?

Atezolizumab binds PD-L1 (the ligand); pembrolizumab binds PD-1 (the receptor on T cells).

With which antibody is atezolizumab combined in hepatocellular carcinoma?

Bevacizumab.

Which three endocrine immune-related adverse events can PD-L1 blockade cause?

Thyroid disorders, hypophysitis, adrenal insufficiency (also type 1 diabetes).

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Connections

← Back to the class: Immune checkpoint inhibitors

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: Atezolizumab Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2023); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.