[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Immune checkpoint inhibitors](https://durgical.com/en/pharmacology/classes/immune-checkpoint-inhibitors/) › Atezolizumab

# 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](https://durgical.com/en/pharmacology/classes/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.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Clinical What the labels mean

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## Mechanism of action

◆**Programmed death-ligand 1 (PD-L1) on tumour and immune cells**Atezolizumab

ⓘ 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](https://www.rcsb.org/structure/5X8L) · Drag to rotate · pinch to zoom

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 →](https://durgical.com/en/conditions/lung-cancer/)
- Unresectable hepatocellular carcinoma, with bevacizumab. [Hepatocellular carcinoma →](https://durgical.com/en/conditions/hepatocellular-carcinoma/)
- BRAF V600-mutant melanoma, with cobimetinib and vemurafenib. [Melanoma →](https://durgical.com/en/conditions/melanoma/)
- Alveolar soft part sarcoma. [Soft tissue sarcomas (liposarcoma, leiomyosarcoma, rhabdomyosarcoma) →](https://durgical.com/en/conditions/soft-tissue-sarcomas/)

## Adverse effects

### Common

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

### Serious (rare, important)

- Immune-mediated pneumonitis
- Immune-mediated colitis
- Immune-mediated hepatitis
- Endocrinopathies: hypophysitis, thyroiditis, adrenal insufficiency, type 1 diabetes
- Immune-mediated nephritis
- Severe skin reactions
- Myocarditis, myositis and neurological reactions (myasthenia, Guillain-Barré syndrome)
- Infusion reactions

## 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.

## Memory aid

«-L1 on the Lump»: atezolizumab targets the ligand on the tumour (PD-L1); the -mabs against PD-1 target the T cell.

## 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).

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/atezolizumab/)

[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## What the labels mean

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

## Connections

## Related drugs 4

- [Pembrolizumab](https://durgical.com/en/pharmacology/pembrolizumab/)
- [Nivolumab](https://durgical.com/en/pharmacology/nivolumab/)
- [Bevacizumab](https://durgical.com/en/pharmacology/bevacizumab/)
- [Vemurafenib](https://durgical.com/en/pharmacology/vemurafenib/)

## Related conditions 4

- [Lung cancer](https://durgical.com/en/conditions/lung-cancer/)
- [Hepatocellular carcinoma](https://durgical.com/en/conditions/hepatocellular-carcinoma/)
- [Melanoma](https://durgical.com/en/conditions/melanoma/)
- [Soft tissue sarcomas (liposarcoma, leiomyosarcoma, rhabdomyosarcoma)](https://durgical.com/en/conditions/soft-tissue-sarcomas/)

[← Back to the class: Immune checkpoint inhibitors](https://durgical.com/en/pharmacology/classes/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](https://medlineplus.gov/druginfo/meds/a616035.html) (MedlinePlus (U.S. National Library of Medicine), 2023); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=L01FF05) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/atezolizumab/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/atezolizumab/