Atezolizumab
A PD-L1 blocker used in lung, liver, and bladder cancer. In 2026 it became the first drug approved based on a blood test showing leftover cancer after bladder surgery.
Approvals in NSCLC (including adjuvant, IMpower010), SCLC (first-line with chemotherapy, IMpower133), HCC (with bevacizumab, IMbrave150), melanoma (with cobimetinib/vemurafenib), alveolar soft-part sarcoma, and Q2 2026 adjuvant ctDNA-positive muscle-invasive bladder cancer (IMvigor011), the first ctDNA-guided approval. Its TNBC indication (IMpassion130) was withdrawn in the US in 2021.
1.Antibody binds PD-L1 on tumour and immune cells
- Route
- IV infusion (subcutaneous Tecentriq Hybreza available)
- Schedule
- 840 mg every 2 weeks, 1200 mg every 3 weeks, or 1680 mg every 4 weeks
- Dose modifications
- Hold for grade 2 immune-mediated events; discontinue for grade 4
- Monitoring
- Thyroid, LFTs, creatinine, glucose
Source: US prescribing information (DailyMed). Doses are for orientation; the current label governs.
- Medicare
- Part B (clinician-administered)
Given by infusion or injection in a clinic or hospital outpatient department, so it is a Part B drug: Medicare pays 80% after the Part B deductible and the patient owes 20% coinsurance, uncapped in Original Medicare unless a Medigap policy applies. HCPCS J9022. Tecentriq Hybreza (subcutaneous) is clinician-administered and Part B.
- Commercial insurance
- covered with prior authorisation
Covered under the medical benefit with prior authorisation confirming diagnosis, biomarker status and line of therapy; site-of-care policies may steer infusions away from hospital outpatient departments.
- Assistance programmes
- Genentech Access Solutions
- Genentech Patient Foundation — Free medicine for eligible patients regardless of insurance type.
- PAN Foundation — Disease-specific co-pay and premium funds; open and closed funds change monthly.
- HealthWell Foundation
- CancerCare Co-Payment Assistance Foundation
- Patient Advocate Foundation Co-Pay Relief
20% Part B coinsurance on a high-cost infusion adds up quickly: Medigap Plan G or N, Medicare Advantage maximum out-of-pocket, Medicaid dual eligibility, or a charity fund are the usual buffers.
Sources: Medicare.gov: Chemotherapy · Medicare.gov: Prescription drugs (outpatient, Part B). Not medical or financial advice; verify with your plan.
- Appraised for
- NSCLC after chemotherapy
- Notes
- Also urothelial (TA492), extensive-stage SCLC with chemotherapy (TA639), HCC with bevacizumab (TA666), 1L NSCLC monotherapy (TA705), adjuvant NSCLC (TA823). The TNBC combination with nab-paclitaxel entered the CDF in 2020 and was later withdrawn after IMpassion131.
- NHS England
- Routinely funded for the appraised indication (or via managed access)
Sources: NICE TA520 · SMC advice: atezolizumab. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
- 18 May 2016ApprovalUS
Urothelial carcinoma after platinum (accelerated; later withdrawn) source
- 18 Oct 2016ApprovalUS
NSCLC after platinum source
- 8 Mar 2019ApprovalUS
PD-L1+ metastatic TNBC with nab-paclitaxel (accelerated; IMpassion130) source
- 18 Mar 2019ApprovalUS
Extensive-stage SCLC with chemotherapy (IMpower133) source
- 29 May 2020ApprovalUS
Unresectable HCC with bevacizumab (IMbrave150) source
- 27 Aug 2021WithdrawalUS
TNBC indication withdrawn after IMpassion131 source
- 15 Oct 2021ApprovalUS
Adjuvant NSCLC, PD-L1 ≥1% (IMpower010) source
- 12 Sept 2024ApprovalUS
Subcutaneous atezolizumab (Tecentriq Hybreza) source
- Q2 2026ApprovalUS
Adjuvant ctDNA-positive muscle-invasive bladder cancer (IMvigor011): first ctDNA-guided indication source
Approvals
| Region | Year | Indication |
|---|---|---|
| US | 2016 | Urothelial carcinoma (later withdrawn); NSCLC |
| US | 2026 | Adjuvant muscle-invasive bladder cancer, ctDNA-positive after cystectomy |
| Adverse event | Any grade | Grade 3+ |
|---|---|---|
| Fatigue/asthenia | 48% | — |
| Decreased appetite | 25% | — |
| Nausea | 24% | — |
| Cough | 22% | — |
| Dyspnoea | 22% | — |
| Hypothyroidism (immune-mediated) | 4.9% | 0.2% |
| Pneumonitis (immune-mediated) | 3% | 0.8% |
| Hepatitis (immune-mediated) | 1.8% | 0.7% |
| Colitis (immune-mediated) | 1% | 0.5% |
Monotherapy pooled. Rates read from the US prescribing information. Blank cells mean the figure was not sourced, not that it is zero.
| Country | Reimbursement | List price | Assistance |
|---|---|---|---|
| United States | Medicare Part B (physician-administered); commercial plans per formulary | not disclosed | genentech-access.com |
| United Kingdom | NICE: recommended in NSCLC (several TAs), SCLC with chemotherapy, HCC with bevacizumab, adjuvant NSCLC | not disclosed | — |
List prices are manufacturer or Medicare figures where publicly disclosed; net prices after rebates are usually lower. Reimbursement changes; check the payer.
Trials
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Landmark trials in OnCo
After bladder removal, a blood test can now tell who needs immunotherapy and who can safely be spared it. This is the model for MRD-guided adjuvant therapy across cancers: treat the blood-positive, watch the blood-negative.
Pancreatic cancer was thought to be immunologically inert because of its low mutation burden; this study showed that with the right vaccine platform its few neoantigens can still be targeted. It is the strongest human evidence so far that personalised cancer vaccines can generate durable, tumour-specific immunity, and it justifies the randomised trials now running in pancreatic cancer and melanoma. Benefit is not yet proven, because responders may simply have had more immunogenic tumours.
Checkpoint inhibitors are now given to hundreds of thousands of patients a year, many in community clinics and emergency departments, so a common, explicit playbook for their autoimmune side effects saves lives. The guideline standardised when to stop, when to give steroids and when to escalate, and made multidisciplinary toxicity teams routine. It does not remove the judgement needed for rare events or for patients whose cancer is responding.
Patients with advanced liver cancer and good liver function should be offered atezolizumab plus bevacizumab (or durvalumab plus tremelimumab) rather than sorafenib as first treatment; median survival is now around 19 months and about a quarter of patients respond. Endoscopy to treat varices before starting bevacizumab is essential because of bleeding risk. Patients with poorer liver function (Child-Pugh B) or autoimmune disease or transplants were not studied.
This study is why PD-1 inhibitors were developed across cancers rather than in melanoma alone: unexpected activity in lung cancer, historically thought immune-resistant, changed drug development priorities industry-wide. It also introduced PD-L1 immunohistochemistry as a candidate biomarker and pneumonitis as a signature toxicity. Within five years PD-1 blockade was approved in more than ten cancers.
Tumours hide from T cells by displaying PD-L1; blocking that interaction lets the immune system attack. This is the mechanism of pembrolizumab, nivolumab, atezolizumab and their relatives, which now treat more than 20 cancer types.
Latest papers
topQuery for this drug: (TITLE:"Atezolizumab" OR ABSTRACT:"Atezolizumab" OR TITLE:"Tecentriq" OR ABSTRACT:"Tecentriq" OR TITLE:"Tecentriq Hybreza" OR ABSTRACT:"Tecentriq Hybreza") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Atezolizumab, not a curated reading list.