1. What is atezolizumab?
2. Who might be offered atezolizumab?
3. How does atezolizumab work?
4. How is atezolizumab given?
5. Side effects of atezolizumab and nab-paclitaxel
6. Blood clots
7. Taking other medications
8. Sex, contraception and pregnancy
11. Further support
Atezolizumab is a targeted (biological) therapy. It’s also referred to as an immunotherapy.
Immunotherapy for treatment of cancer helps the immune system to recognise and attack cancer cells.
Atezolizumab is the drug’s generic (non-branded) name. Its brand name is Tecentriq.
When used to treat breast cancer, atezolizumab is given alongside the chemotherapy drug nab-paclitaxel (Abraxane) which combines the chemotherapy drug paclitaxel with a protein called albumin.
Atezolizumab may be offered to people who:
- Have triple negative, locally advanced or secondary breast cancer that has a higher than normal level of a protein called PDL1
- And have not previously received chemotherapy treatment for their locally advanced or secondary breast cancer
Atezolizumab is not currently given for primary (early) triple negative breast cancer. However, clinical trials are looking at whether it may be useful.
You may be offered atezolizumab as part of a clinical trial.
Our immune (defence) system usually protects us from infection and illness by recognising and attacking unfamiliar substances and germs like viruses and bacteria, and abnormal cells like cancer cells. Sometimes the body’s natural immune system is not able to do this.
PDL1 is a protein that stops the body’s own immune system from attacking cells in the body.
Some cancer cells have a higher than normal level of PDL1. This allows the cancer cells to trick the immune system, and avoid being attacked as abnormal cells, so they can continue to grow.
Atezolizumab blocks the PDL1 protein, allowing the natural immune system to recognise and destroy these breast cancer cells.
How do I know if my breast cancer is PDL1 positive or PDL1 negative?
Triple negative breast cancers can be tested for PDL1 levels. This is done in a laboratory on a sample of breast cancer tissue removed during a biopsy. Your treatment team may discuss performing a biopsy of the secondary breast cancer to test for this.
If the biopsy shows that the cells in your breast cancer have high levels of PDL1, you may be offered atezolizumab as part of your treatment.
When used to treat secondary breast cancer, atezolizumab is given in combination with the chemotherapy drug nab-paclitaxel (Abraxane).
Nab-paclitaxel is given as an intravenous (into a vein) infusion over four-weeks. This is usually every week for three weeks followed by a one-week break. This four-week timeframe is known as a cycle. Nab paclitaxel is given over 30 minutes.
Atezolizumab is given every two weeks as an intravenous infusion. The first infusion of atezolizumab is usually given over an hour. Future doses may be given over 30 minutes.
You’ll be asked to stay in the hospital for several hours after your first few treatments to ensure you’re not feeling unwell.
The most common way of giving chemotherapy involves inserting a small needle and plastic tube called a cannula into a vein, either in the back of the hand or lower arm. The needle is removed and the plastic tube left in place.
Other intravenous methods may be used depending on factors such as how easy it is for chemotherapy staff to find suitable veins, and your preferences.
How long will I have atezolizumab for?
You’ll be given atezolizumab with nab-paclitaxel for as long as your treatment team feels you’re benefiting from these drugs. This will vary from person to person.
It may be stopped if you experience significant side effects.
Like any drugs, atezolizumab and nab-paclitaxel can cause side effects.
Side effects from atezolizumab can occur in any part of the body at any time during treatment. They can also sometimes occur months after treatment has finished. Some side effects may need to be treated immediately, so it’s important to be familiar with them and report them as soon as possible.
You should be given an alert card to carry with you at all times while having atezolizumab. This card lists the symptoms you must report to your treatment team and your team’s contact details, including who to contact out of hours.
Everyone reacts differently to drugs and some people have more side effects than others. Many side effects can be controlled and those described here will not affect everyone.
This information does not list all the possible side effects of atezolizumab and nab-paclitaxel. If you’re concerned about any side effects, regardless of whether they’re listed here or on the alert card, contact your treatment team.
Effects of atezolizumab on your immune system
Rarely, atezolizumab may cause immune-related side effects. This is when healthy cells get destroyed by the body's immune system and cause inflammation of the tissues and organs. Reporting symptoms to your treatment team and getting medical treatment quickly is important to help prevent the effects worsening. Your alert card will also list these symptoms to report immediately.
Symptoms to report:
- A new or worsening cough, shortness of breath or chest pain (inflammation of the lungs)
- Persistent diarrhoea, blood or mucus in your poo dark coloured poo or abdominal pain (inflammation of the bowel)
- Yellowing of the skin or whites of the eyes, severe nausea (feeling sick) and vomiting (being sick), bleeding and bruising, dark coloured urine or pain in the upper abdomen (inflammation of the liver)
- Extreme tiredness (fatigue), persistent headaches, weight change, change in mood, unusual bowel habits, dizziness, feeling more hungry or thirsty than usual, passing urine more often, increased sensitivity to heat or cold (inflammation of hormone-producing glands such as the thyroid or pituitary)
- Chest pain, shortness of breath, irregular heartbeat, not being able to exercise for as long as normal, swelling of the ankles (inflammation of the heart)
- Neck stiffness, headache, fever, chills, vomiting (being sick), eye sensitivity to light, confusion, not being able to sleep (inflammation of the brain tissue or lining)
- Severe muscle weakness, changed sensation, difficulty swallowing (inflammation of the nerves)
- Abdominal pain, nausea (feeling sick) and vomiting (being sick) (inflammation of the pancreas)
- Changes in vision, blurry or double vision, eye pain or redness (inflammation of the eyes)
- Changes in how often you pass urine and changes to urine colour, swelling anywhere in the body, pain in the lower abdomen (pelvis) (inflammation of the kidneys)
Common side effects
Effects on the blood
Treatment with atezolizumab and nab-paclitaxel can temporarily affect the number of blood cells in the body.
You’ll have regular blood tests to check your numbers of blood cells. If the number is too low, your next cycle of atezolizumab may be delayed or the dose of nab-paclitaxel reduced.
Risk of infection
Not having enough white blood cells can increase the risk of getting an infection. Contact your hospital immediately if:
- You have a high temperature (over 37.5°C) or low temperature (under 36°C), or whatever your chemotherapy team has advised
- You suddenly feel unwell, even with a normal temperature
- You have any symptoms of an infection, for example a sore throat, a cough, a need to pass urine frequently or feeling cold or shivery
Before starting treatment you should be given a 24-hour contact number or told where to get emergency care by your treatment team.
Having too few red blood cells is called anaemia. If you feel particularly tired, breathless or dizzy, let your treatment team know.
You may also bruise more easily, have nosebleeds or your gums may bleed when you brush your teeth. Tell your treatment team if you have any of these symptoms.
Nausea and vomiting
You may experience nausea (feeling sick) and vomiting (being sick). Anti-sickness drugs can be prescribed to help with this. If you still experience nausea or vomiting contact your treatment team as they may be able to recommend a different anti-sickness drug and change your prescription for next time.
Loss of appetite
You may not feel like eating, especially if you feel sick. It might help to eat small meals regularly and drink plenty of liquids. You can also ask your doctor to refer you to a dietitian for more advice.
Other effects on your digestive system
Atezolizumab and nab-pacilitaxel may affect your digestive system in different ways. Some people get constipated, while others have diarrhoea.
Let your treatment team know if you have either of these. They can prescribe medications to help.
Fatigue (extreme tiredness)
It’s common to feel extremely tired during your treatment. There are different ways of coping with and managing fatigue.
You can speak to your treatment team or contact our Helpline for more information and support.
If you feel extremely tired, unable to get up, are dizzy or faint, contact your treatment team straight away.
Painful muscles and joints
Your back, muscles or joints may ache or become painful after you’ve had your treatment. This usually wears off after a few days or about a week but can sometimes be severe or last a bit longer. You may find it helpful to take pain relief or anti-inflammatory drugs. It’s a good idea to have some of these available before starting your treatment just in case you need them. However, it’s important to be aware that pain relief such as paracetamol or ibuprofen can mask the signs of infection. See the section above for more information about infection.
You may develop a rash on your body or your skin might discolour. This could be red and itchy, or you may feel flushed. If you have skin reactions, tell your treatment team so they can monitor your symptoms as they might be able to prescribe medicine to help. Contact your treatment team if the rash covers a lot of your body.
After a few cycles of nab-paclitaxel, the colour of your nails may change. The nails could also become brittle, crack or change in texture, for example ridges may form. Some people might lose nails on their fingers or toes during treatment, but they usually grow back.
Hair thinning and hair loss is common when receiving atezolizumab and nab-paclitaxel. Find out more about hair loss.
Numbness and tingling in hands or feet
Some people having nab-paclitaxel experience numbness or tingling in their hands and feet. This is due to the effect the drug can have on the nerves and is known as peripheral neuropathy. In most cases it’s mild and goes away soon after treatment stops. If it’s severe, it may be necessary to reduce the dose of nab-paclitaxel or stop it completely. It normally improves a few months after the treatment has finished, but it may not disappear completely.
If you have pain, tingling or numbness (such as difficulty doing up buttons, or difficulty feeling the difference between hot and cold water with your fingertips), mention this to your treatment team when you see them next so that the symptoms can be monitored.
Less common side effects
Sore mouth and taste changes
Your mouth may become sore and small ulcers can develop. You’ll usually be given mouthwash to try to reduce soreness of the mouth and gums. Good mouth hygiene is very important during treatment. For more information on coping with a sore mouth, see our Chemotherapy for breast cancer booklet.
It’s advisable to see your dentist for a dental check-up before treatment begins.
If you need dental work during treatment you can talk to your oncologist about the best time to have this.
Your taste can change and some food may taste different, for example more salty, bitter or metallic.
Our information on diet during breast cancer treatment includes tips on dealing with taste changes.
Allergic and infusion reactions
Very occasionally allergic reactions to atezolizumab or nab-paclitaxel can occur. Reactions can vary from mild to severe, although severe reactions are uncommon. If you have any swelling, wheezing, chest pain or difficulty breathing after having treatment with atezolizumab and nab-paclitaxel, contact your hospital immediately.
People with breast cancer have a higher risk of blood clots, such as deep vein thrombosis (DVT). Their risk is higher because of the cancer itself and some treatments for breast cancer. Nab-paclitaxel is a treatment that can cause blood clots If the cancer has spread to other parts of the body (secondary breast cancer), this also increases the risk.
Blood clots can be harmful but are treatable, so it’s important to report symptoms as soon as possible.
If you experience any of the following symptoms contact your local A&E department, GP or treatment team straight away:
- Pain, redness/discolouration, heat and swelling of the calf, leg or thigh
- Swelling, redness or tenderness where a central line is inserted to give chemotherapy, for example in the arm, chest area or up into the neck
- Shortness of breath
- Tightness in the chest
- Unexplained cough (may cough up blood)
It’s important to tell your specialist about any prescribed or over-the-counter medicines you’re taking including any herbal medicines or supplements. This includes any herbal medicines or supplements, such as steroids or drugs that affect the body’s immune system.
Taking atezolizumab while pregnant may be harmful to a developing baby. Some women can still become pregnant even if their periods are irregular or have stopped. You should continue using an effective barrier contraception during treatment, such as condoms or Femidoms, and for at least five months after treatment has finished.
Nab-paclitaxel may affect male and female fertility. It’s not known whether atezolizumab affects fertility.
You’ll probably be advised not to breastfeed during treatment. This is because there is a chance your baby may absorb the drug through your breast milk, which could cause harm.
Always check with your treatment team before having any kind of immunisation or vaccination while receiving treatment with atezolizumab and nab paclitaxel.
Being diagnosed with secondary breast cancer can make you feel lonely and isolated.
If you would like any further information and support about breast cancer or just want to talk things through, you can speak to one of our experts by calling our free Helpline on 0808 800 6000.