1. What is atezolizumab?
Atezolizumab is a targeted therapy. It’s also referred to as an immunotherapy.
Immunotherapy cancer treatments use the body’s natural defence system (immune system) to help them fight cancer.
Atezolizumab is the drug’s non-branded name. Its brand name is Tecentriq.
When used to treat breast cancer, atezolizumab is given alongside the drug nab-paclitaxel (Abraxane). Nab-paclitaxel is different from the chemotherapy drug paclitaxel. It combines paclitaxel with a protein called albumin.
2. Who might be offered atezolizumab?
You may be offered atezolizumab if you:
- Have triple negative or that cannot be removed by surgery and has a higher-than-normal level of a protein called PDL1
- And have not previously had chemotherapy treatment for your locally advanced or secondary breast cancer
You may be tested first to see if you would benefit from another similar drug called pembrolizumab.
You may also be offered atezolizumab as part of a clinical trial.
3. How does atezolizumab work?
Your immune system usually protects you from infection and illness. It does this 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 usually stops your immune system attacking healthy cells in the body.
Some breast cancer cells have a higher-than-normal level of PDL1. This allows them to trick your immune system and avoid being attacked as abnormal cells. They can then continue to grow.
Atezolizumab blocks the PDL1 protein, helping your immune system find and destroy breast cancer cells.
Breast cancer that has a higher-than-normal level of PDL1 is called PDL1-positive.
How do I know if my breast cancer is PDL1-positive or PDL1-negative?
Triple negative breast cancers can be tested for PDL1 levels. You’ll have a where a sample of breast cancer tissue is removed and sent to a laboratory for testing.
Your treatment team may also discuss doing a biopsy of an area of to test for this.
If the biopsy shows the cells in your breast cancer have high levels of PDL1 and are therefore PDL1-positive, you may be offered atezolizumab.
4. How is atezolizumab given?
When used to treat breast cancer, atezolizumab is given in combination with the chemotherapy drug nab-paclitaxel (Abraxane).
Atezolizumab may be given:
- As a drip into a vein (intravenously), usually in the hand or arm
- As an injection into the fatty tissue under the skin (subcutaneous injection) in your thigh
It’s usually given once every 2 weeks. This is known as a cycle.
Into a vein
You’ll usually have your first infusion over 1 hour. Future doses may be given over 30 minutes.
The drug may be given through a tube put into your vein (cannula) each time you have treatment. It can also be given through a device that stays in place throughout the course of treatment, such as a central line or port. Find out more about the different ways chemotherapy can be given.
As an injection
It usually takes around 7 minutes to give the injection.
It’s given into the right and left thighs alternately.
Nab-paclitaxel
The chemotherapy drug nab-paclitaxel is usually given every week for 3 weeks followed by a 1-week break. You’ll be given nab-paclitaxel over 30 minutes during each session.
You may be asked to stay in the hospital for several hours after your first few treatments to make sure you're feeling well.
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 benefitting from these drugs. This will vary from person to person.
It may be stopped if you have significant side effects.
5. Side effects of atezolizumab and nab-paclitaxel
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. You may have them months after treatment has finished.
Reporting side effects
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 with 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
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.
Symptoms can vary depending on where in the body the inflammation is and can appear at any time during or after treatment.
Reporting symptoms to your treatment team and getting medical treatment quickly is important to help prevent the side effects worsening. Your alert card will also list these symptoms to report immediately.
Lung inflammation
- A new or worsening cough
- Shortness of breath
- Chest pain
Bowel inflammation
- Diarrhoea that does not go away
- Blood or mucus in your poo
- Dark coloured poo
- Tummy pain
Liver inflammation
- Yellowing of the skin or whites of the eyes
- Feeling sick (nausea) and being sick (vomiting)
- Bleeding and bruising more easily than normal
- Dark coloured urine
- Pain in the upper tummy
Inflammation of the hormone glands
- Extreme tiredness (fatigue)
- Headache that does not go away
- Changes to your weight
- Changes to your mood
- Changes to your bowel habits like diarrhoea or constipation
- Dizziness
- Feeling more hungry or thirsty than usual
- Passing urine more often than usual
- Increased sensitivity to heat or cold
Heart inflammation
- Chest pain
- Shortness of breath
- Irregular heartbeat
- Not being able to exercise for as long as normal
- Swelling of the ankles
Brain inflammation
- Neck stiffness
- Headache
- Fever
- Chills
- Being sick (vomiting)
- Eye sensitivity to light
- Confusion
- Difficulty sleeping
Nerve inflammation
- Severe muscle weakness
- Changed sensation, like numbness or pins and needles
- Difficulty swallowing
- Difficulty walking
Pancreas inflammation
- Tummy pain
- Feeling sick (nausea) and being sick (vomiting)
Eye inflammation
- Changes to your vision
- Blurry or double vision
- Eye pain or redness
Kidney inflammation
- Passing urine more or less often than usual
- Changes to your urine colour
- Swelling anywhere in the body
- Pain in the lower tummy (pelvis)
Common side effects
Effects on the blood
Treatment with atezolizumab and nab-paclitaxel can temporarily affect the number of blood cells in the body. Blood is made up of red cells, white cells and platelets.
You’ll have regular blood tests. If these show the number of blood cells is too low, your next cycle of atezolizumab may be delayed or the dose of nab-paclitaxel reduced.
Treatment teams often tailor the dose of a drug by reducing it to suit an individual and to help manage its side effects. This can sometimes help you stay on a treatment for longer.
Risk of infection
Not having enough white blood cells can increase the risk of getting an infection.
Signs of an infection
Your treatment team may give you guidelines to follow for reporting signs of an infection. But generally you should contact your hospital immediately if you experience any of the following:
- A high temperature (over 37.5°C) or low temperature (under 36°C), or whatever your treatment team has advised
- Suddenly feeling unwell, even with a normal temperature
- 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 go for emergency care by your treatment team.
If you get an infection you may need treatment.
Sometimes your treatment team may recommend injections of drugs called growth factors. This helps the body produce more white blood cells to reduce your risk of infection.
Anaemia
Having too few red blood cells is called anaemia. If you feel particularly tired, breathless or dizzy, let your treatment team know.
Bruising and bleeding
Atezolizumab can reduce the number of platelets. Platelets help the blood to clot.
If your platelets are low you may 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.
Feeling sick (nausea) and being sick (vomiting)
You may have nausea and vomiting.
You’ll be given anti-sickness medication before you have chemotherapy. You’ll also be given anti-sickness tablets to take at home.
If you continue to feel sick or vomit, tell your treatment team as they may be able to change your anti-sickness drugs.
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 treatment team to refer you to a dietitian for more advice.
Constipation and diarrhoea
Atezolizumab and nab-paclitaxel 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.
Contact your chemotherapy team if you have diarrhoea 4 or more times in 24 hours.
Extreme tiredness (cancer-related fatigue)
Cancer-related fatigue is 1 of the most common symptoms in people with secondary breast cancer.
Fatigue is extreme tiredness that does not go away with rest or sleep. It has many causes, from the emotional impact of a diagnosis to side effects of treatment or growth and spread of the cancer.
Fatigue may affect how you cope with your cancer and its treatment. It can also make everyday activities harder and affect your quality of life.
Find out more about managing fatigue.
Painful muscles and joints
Your muscles or joints may ache or become painful after you’ve had your treatment. This usually wears off after a few days to a week but may last a bit longer for some people.
It can be very painful and you may need to take pain relief or anti-inflammatory drugs such as ibuprofen. It’s a good idea to have these available before starting your treatment just in case you need them. Be aware that pain relief such as paracetamol or ibuprofen can mask the signs of infection.
Before using anti-inflammatory pain relief, ask your doctor about the correct dose, how long you should use it for and any possible side effects, especially if you have a stomach ulcer or asthma.
Skin reactions
You may develop a rash on your body, or your skin might look a different colour (discoloured). This could be red or darkened and itchy, or you may feel flushed.
If you have a skin reaction, tell your treatment team so they can monitor your symptoms. They may be able to prescribe medicine to help. Contact your treatment team if the rash covers a large area of your body.
Nail changes
After a few cycles of nab-paclitaxel, the colour of your nails may change. They could also become brittle, crack or change in texture, for example ridges may form. Some people lose nails on their fingers or toes during treatment, but they usually grow back.
Hair loss
Atezolizumab and nab-paclitaxel can cause hair thinning and hair loss.
Any hair loss caused should be temporary and in most cases your hair will begin to grow back once your treatment has ended.
Read more information about hair loss.
Numbness and tingling in your hands or feet
You may have numbness or tingling in your hands or feet while having nab-paclitaxel. 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 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), let your treatment team know so they can monitor your symptoms.
Less common side effects
Sore mouth
Your mouth may become sore and small ulcers may develop. Looking after your mouth, including your teeth and gums, is very important during treatment.
You’ll usually be given mouthwash to try to reduce any soreness and stop mouth ulcers developing.
See your dentist for a check-up before treatment with atezolizumab and nab-paclitaxel begins. Avoid dental work during treatment if possible.
If you do need to have dental work during treatment, talk with your treatment team about the best time to have this.
Taste changes
Your taste may change and some foods may taste different, for example more salty, bitter or metallic.
Our information on diet during breast cancer treatment includes tips for dealing with taste changes.
Allergic reaction
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 atezolizumab and nab-paclitaxel, contact your treatment team or go to your local A&E immediately.
6. Other important information
Blood clots
People with breast cancer have a higher risk of blood clots. Having atezolizumab with nab-paclitaxel also increases the risk of blood clots such as a DVT (deep vein thrombosis).
If you have a DVT, there’s a risk part of the blood clot could break away and travel to the lung. This is known as a pulmonary embolism (PE).
Blood clots can be life-threatening and should be treated quickly.
Blood clot symptoms
Contact your treatment team or go to your local A&E department straight away if you have any of the following symptoms:
- Pain, redness/discolouration of the skin, heat and swelling of the arm or leg
- 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 that comes on suddenly
- Pain or tightness in the chest
- Unexplained cough or coughing up blood
Find out more about blood clots.
Taking other medications
It’s important to tell your treatment team about any prescribed or over-the-counter medicines you’re taking. This includes any herbal medicines or supplements, steroids or drugs that affect the body’s immune system.
Sex, contraception and pregnancy
You can still have sex during treatment. It’s thought chemotherapy drugs cannot pass into vaginal fluids or semen, but this cannot be completely ruled out.
Treatment teams will advise using barrier methods of contraception, such as condoms, during treatment and for a few days after chemotherapy is given.
You’re advised not to become pregnant while having treatment because atezolizumab and nab-paclitaxel may harm a developing baby. If you have not been through the menopause, talk to your treatment team about the most suitable method of contraception for you. It’s still possible to become pregnant even if your periods are irregular or have stopped.
Find out more about how breast cancer and its treatment can affect sex and intimacy and read our tips on how to manage these changes.
Breastfeeding
Breastfeeding is not recommended while having atezolizumab and nab-paclitaxel. This is because there’s a risk the drugs could be passed on through breast milk.
Vaccinations and travel
Travel vaccinations
If you’re planning a holiday or need to travel overseas, check with your treatment team first.
You should not have any live vaccines while you’re having chemotherapy.
Live vaccines include:
- Mumps
- Measles
- Rubella (German measles)
- Polio
- BCG (tuberculosis)
- Yellow fever
- A certain shingles vaccine (Zostavax)
Live vaccines contain a small amount of live virus or bacteria. If you have a weakened immune system, which you may do during chemotherapy, they could be harmful.
It’s usually safe to have these vaccinations 6 months after your treatment finishes. Talk to your GP or treatment team before having any vaccinations.
If anyone you have close contact with needs to have a live vaccine, speak to your treatment team or GP. They can advise what precautions you may need to take depending on the type of vaccination.
COVID-19 vaccination
If you’re having chemotherapy or targeted therapies, you’re advised to speak to your treatment team about the best time to have a COVID-19 vaccination.
Flu vaccination
Anyone at risk of a weakened immune system, and therefore more prone to infection, should have the flu vaccine. This includes people due to have, or already having, chemotherapy.
The flu vaccine is not a live vaccine so does not contain any active viruses.
Talk to your treatment team or breast care nurse about the best time to have your flu jab.
7. Further support
If you’ve been diagnosed with secondary breast cancer, you might be feeling lonely or isolated. Many people experience this and support is available.
Some people find it helps to talk to someone who has been through the same experience as them. You might find it helpful to join 1 of our Live Chat sessions or visit our confidential online forum.
Our Living with Secondary Breast Cancer services are also here for you. Choose the type of support that suits you and you’ll be able to talk, listen and learn with people who understand the challenges that secondary breast cancer can bring. Find out more below.
