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Tecentriq

Last reviewed on RxList: 6/12/2020
Tecentriq Side Effects Center

Medical Editor: John P. Cunha, DO, FACOEP

What Is Tecentriq?

Tecentriq (atezolizumab) Injection for intravenous infusion is a monoclonal antibody indicated for the treatment of patients with locally advanced or metastatic urothelial carcinoma (cancer) who have disease progression during or following platinum-containing chemotherapy, or have disease progression within 12 months of neoadjuvant or adjuvant treatment with platinum-containing chemotherapy.

What Are Side Effects of Tecentriq?

Common side effects of Tecentriq include:

Dosage for Tecentriq

The recommended dose of Tecentriq is 1200 mg administered as an intravenous infusion over 60 minutes every 3 weeks until disease progression or unacceptable toxicity.

What Drugs, Substances, or Supplements Interact with Tecentriq?

Tecentriq may interact with other drugs. Tell your doctor all medications and supplements you use.

Tecentriq During Pregnancy and Breastfeeding

Tecentriq is not recommended during pregnancy; it may harm a fetus. Breastfeeding is not recommended while taking Tecentriq and for at least 5 months after the last dose.

Additional Information

Our Tecentriq (atezolizumab) Injection for Intravenous Infusion Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

SLIDESHOW

Prostate Cancer Symptoms, PCA Test, Treatments See Slideshow
Tecentriq Professional Information

SIDE EFFECTS

The following adverse reactions are discussed in greater detail in other sections of the label:

  • Immune-Mediated Pneumonitis [see WARNINGS AND PRECAUTIONS]
  • Immune-Mediated Hepatitis [see WARNINGS AND PRECAUTIONS]
  • Immune-Mediated Colitis [see WARNINGS AND PRECAUTIONS]
  • Immune-Mediated Endocrinopathies [see WARNINGS AND PRECAUTIONS]
  • Other Immune-Mediated Adverse Reactions [see WARNINGS AND PRECAUTIONS]
  • Infections [see WARNINGS AND PRECAUTIONS]
  • Infusion-Related Reactions [see WARNINGS AND PRECAUTIONS]

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

The data described in WARNINGS AND PRECAUTIONS reflect exposure to TECENTRIQ as a single-agent in 2616 patients in two randomized, active-controlled studies (POPLAR, OAK) and four open-label, single arm studies (PCD4989g, IMvigor210, BIRCH, FIR) which enrolled 524 patients with metastatic urothelial carcinoma, 1636 patients with metastatic NSCLC, and 456 patients with other tumor types. TECENTRIQ was administered at a dose of 1200 mg intravenously every 3 weeks in all studies except PCD4989g. Among the 2616 patients who received a single-agent TECENTRIQ, 36% were exposed for longer than 6 months and 20% were exposed for longer than 12 months. Using the dataset described for patients who received TECENTRIQ as a single-agent, the most common adverse reactions in ≥ 20% of patients were fatigue/asthenia (48%), decreased appetite (25%), nausea (24%), cough (22%), and dyspnea (22%).

In addition, the data reflect exposure to TECENTRIQ in combination with other antineoplastic drugs in 2421 patients with NSCLC (N = 2223) or SCLC (N = 198) enrolled in five randomized, active-controlled trials, including IMpower150, IMpower130 and IMpower133. Among the 2421 patients, 53% were exposed to TECENTRIQ for longer than 6 months and 29% were exposed to TECENTRIQ for longer than 12 months. Among the 2421 patients with NSCLC and SCLC who received TECENTRIQ in combination with other antineoplastic drugs, the most common adverse reactions in ≥20% of patients were fatigue/asthenia (49%), nausea (38%), alopecia (35%), constipation (29%), diarrhea (28%) and decreased appetite (27%).

Urothelial Carcinoma

Cisplatin-Ineligible Patients With Locally Advanced Or Metastatic Urothelial Carcinoma

The safety of TECENTRIQ was evaluated in IMvigor 210 (Cohort 1), a multicenter, open-label, single-arm trial that included 119 patients with locally advanced or metastatic urothelial carcinoma who were ineligible for cisplatin-containing chemotherapy and were either previously untreated or had disease progression at least 12 months after neoadjuvant or adjuvant chemotherapy [see Clinical Studies]. Patients received TECENTRIQ 1200 mg intravenously every 3 weeks until either unacceptable toxicity or disease progression. The median duration of exposure was 15 weeks (0 to 87 weeks).

Five patients (4.2%) who were treated with TECENTRIQ experienced one of the following events which led to death: sepsis, cardiac arrest, myocardial infarction, respiratory failure, or respiratory distress. One additional patient (0.8%) was experiencing herpetic meningoencephalitis and disease progression at the time of death.

Serious adverse reactions occurred in 37% of patients. The most frequent serious adverse reactions (≥ 2%) were diarrhea, intestinal obstruction, sepsis, acute kidney injury, and renal failure.

TECENTRIQ was discontinued for adverse reactions in 4.2% of patients. The adverse reactions leading to discontinuation were diarrhea/colitis (1.7%), fatigue (0.8%), hypersensitivity (0.8%), and dyspnea (0.8%).

Adverse reactions leading to interruption occurred in 35% of patients; the most common (≥ 1%) were intestinal obstruction, fatigue, diarrhea, urinary tract infection, infusion-related reaction, cough, abdominal pain, peripheral edema, pyrexia, respiratory tract infection, upper respiratory tract infection, creatinine increase, decreased appetite, hyponatremia, back pain, pruritus, and venous thromboembolism.

Tables 2 and 3 summarize the adverse reactions and Grades 3-4 selected laboratory abnormalities, respectively, in patients who received TECENTRIQ in IMvigor210 (Cohort 1).

Table 2: Adverse Reactions in ≥ 10% of Patients with Urothelial Carcinoma in IMvigor210 (Cohort 1)

Adverse Reaction TECENTRIQ
N = 119
All Grades (%) Grades 3-4 (%)
General
Fatigue1 52 8
Peripheral edema2 17 2
Pyrexia 14 0.8
Gastrointestinal
Diarrhea3 24 5
Nausea 22 2
Vomiting 16 0.8
Constipation 15 2
Abdominal pain4 15 0.8
Metabolism and Nutrition
Decreased appetite5 24 3
Musculoskeletal and Connective Tissue
Back/Neck pain 18 3
Arthralgia 13 0
Skin and Subcutaneous Tissue
Pruritus 18 0.8
Rash6 17 0.8
Infections
Urinary tract infection7 17 5
Respiratory, Thoracic, and Mediastinal
Cough8 14 0
Dyspnea9 12 0
1 Includes fatigue, asthenia, lethargy, and malaise
2 Includes edema peripheral, scrotal edema, lymphedema, and edema
3 Includes diarrhea, colitis, frequent bowel movements, autoimmune colitis
4 Includes abdominal pain, upper abdominal pain, lower abdominal pain, and flank pain
5 Includes decreased appetite and early satiety
6 Includes rash, dermatitis, dermatitis acneiform, rash maculo-papular, rash erythematous, rash pruritic, rash macular, and rash papular
7 Includes urinary tract infection, urinary tract infection bacterial, cystitis, and urosepsis
8 Includes cough and productive cough
9 Includes dyspnea and exertional dyspnea

Table 3: Grades 3-4 Laboratory Abnormalities in ≥ 1% of Patients with Urothelial Carcinoma in IMvigor210 (Cohort 1)

Laboratory Abnormality Grades 3-4 (%)
Chemistry
Hyponatremia 15
Hyperglycemia 10
Increased Alkaline Phosphatase 7
Increased Creatinine 5
Hypophosphatemia 4
Increased ALT 4
Increased AST 4
Hyperkalemia 3
Hypermagnesemia 3
Hyperbilirubinemia 3
Hematology
Lymphopenia 9
Anemia 7

Previously Treated Locally Advanced Or Metastatic Urothelial Carcinoma

The safety of TECENTRIQ was evaluated in IMvigor210 (Cohort 2), a multicenter, open-label, single-arm trial that included 310 patients with locally advanced or metastatic urothelial carcinoma who had disease progression during or following at least one platinum-containing chemotherapy regimen or who had disease progression within 12 months of treatment with a platinum-containing neoadjuvant or adjuvant chemotherapy regimen [see Clinical Studies]. Patients received TECENTRIQ 1200 mg intravenously every 3 weeks until unacceptable toxicity or either radiographic or clinical progression. The median duration of exposure was 12.3 weeks (0.1 to 46 weeks).

Three patients (1%) who were treated with TECENTRIQ experienced one of the following events which led to death: sepsis, pneumonitis, or intestinal obstruction.

TECENTRIQ was discontinued for adverse reactions in 3.2% of patients. Sepsis led to discontinuation in 0.6% of patients.

Serious adverse reactions occurred in 45% of patients. The most frequent serious adverse reactions (> 2%) were urinary tract infection, hematuria, acute kidney injury, intestinal obstruction, pyrexia, venous thromboembolism, urinary obstruction, pneumonia, dyspnea, abdominal pain, sepsis, and confusional state.

Adverse reactions leading to interruption occurred in 27% of patients; the most common (> 1%) were liver enzyme increase, urinary tract infection, diarrhea, fatigue, confusional state, urinary obstruction, pyrexia, dyspnea, venous thromboembolism, and pneumonitis.

Tables 4 and 5 summarize the adverse reactions and Grades 3-4 selected laboratory abnormalities, respectively, in patients who received TECENTRIQ in IMvigor210 (Cohort 2).

Table 4: Adverse Reactions in ≥ 10% of Patients with Urothelial Carcinoma in IMvigor210 (Cohort 2)

Adverse Reaction TECENTRIQ
N = 310
All Grades (%) Grades 3-4 (%)
General
Fatigue 52 6
Pyrexia 21 1
Peripheral edema 18 1
Metabolism and Nutrition
Decreased appetite 26 1
Gastrointestinal
Nausea 25 2
Constipation 21 0.3
Diarrhea 18 1
Abdominal pain 17 4
Vomiting 17 1
Infections
Urinary tract infection 22 9
Respiratory, Thoracic, and Mediastinal
Dyspnea 16 4
Cough 14 0.3
Musculoskeletal and Connective Tissue
Back/Neck pain 15 2
Arthralgia 14 1
Skin and Subcutaneous Tissue
Rash 15 0.3
Pruritus 13 0.3
Renal and Urinary
Hematuria 14 3

Table 5: Grades 3-4 Laboratory Abnormalities in ≥ 1% of Patients with Urothelial Carcinoma in IMvigor210 (Cohort 2)

Laboratory Abnormality Grades 3-4 (%)
Chemistry
Hyponatremia 10
Hyperglycemia 5
Increased Alkaline Phosphatase 4
Increased Creatinine 3
Increased ALT 2
Increased AST 2
Hypoalbuminemia 1
Hematology
Lymphopenia 10
Anemia 8

Non-Small Cell Lung Cancer (NSCLC)

IMpower150

The safety of TECENTRIQ with bevacizumab, paclitaxel and carboplatin was evaluated in IMpower150, a multicenter, international, randomized, open-label trial in which 393 chemotherapy-naive patients with metastatic non-squamous NSCLC received TECENTRIQ 1200 mg with bevacizumab 15 mg/kg, paclitaxel 175 mg/m² or 200 mg/m², and carboplatin AUC 6 mg/mL/min intravenously every 3 weeks for a maximum of 4 or 6 cycles, followed by TECENTRIQ 1200 mg with bevacizumab 15 mg/kg intravenously every 3 weeks until disease progression or unacceptable toxicity [see Clinical Studies]. The median duration of exposure to TECENTRIQ was 8.3 months in patients receiving TECENTRIQ with bevacizumab, paclitaxel, and carboplatin.

Fatal adverse reactions occurred in 6% of patients receiving TECENTRIQ; these included hemoptysis, febrile neutropenia, pulmonary embolism, pulmonary hemorrhage, death, cardiac arrest, cerebrovascular accident, pneumonia, aspiration pneumonia, chronic obstructive pulmonary disease, intracranial hemorrhage, intestinal angina, intestinal ischemia, intestinal obstruction and aortic dissection.

Serious adverse reactions occurred in 44%. The most frequent serious adverse reactions (>2%) were febrile neutropenia, pneumonia, diarrhea, and hemoptysis.

TECENTRIQ was discontinued due to adverse reactions in 15% of patients; the most common adverse reaction leading to discontinuation was pneumonitis (1.8%).

Adverse reactions leading to interruption of TECENTRIQ occurred in 48%; the most common (>1%) were neutropenia, thrombocytopenia, fatigue/asthenia, diarrhea, hypothyroidism, anemia, pneumonia, pyrexia, hyperthyroidism, febrile neutropenia, increased ALT, dyspnea, dehydration and proteinuria.

Tables 6 and 7 summarize adverse reactions and laboratory abnormalities in patients receiving TECENTRIQ with bevacizumab, paclitaxel, and carboplatin in IMpower150. Study IMpower150 was not designed to demonstrate a statistically significant reduction in adverse reaction rates for TECENTRIQ, as compared to the control arm, for any specified adverse reaction or laboratory abnormality listed in Tables 6 and 7.

Table 6: Adverse Reactions Occurring in ≥15% of Patients with NSCLC Receiving TECENTRIQ in IMpower150

Adverse Reaction TECENTRIQ with Bevacizumab, Paclitaxel, and Carboplatin
N = 393
Bevacizumab, Paclitaxel and Carboplatin
N = 394
All Grades* (%) Grades 3-4* (%) All Grades* (%) Grades 3-4* (%)
Nervous System
Neuropathy1 56 3 47 3
Headache 16 0.8 13 0
General
Fatigue/Asthenia 50 6 46 6
Pyrexia 19 0.3 9 0.5
Skin and Subcutaneous Tissue
Alopecia 48 0 46 0
Rash2 23 2 10 0.3
Musculoskeletal and Connective Tissue
Myalgia/Pain3 42 3 34 2
Arthralgia 26 1 22 1
Gastrointestinal
Nausea 39 4 32 2
Diarrhea4 33 6 25 0.5
Constipation 30 0.3 23 0.3
Vomiting 19 2 18 1
Metabolism and Nutrition
Decreased appetite 29 4 21 0.8
Vascular
Hypertension 25 9 22 8
Respiratory
Cough 20 0.8 19 0.3
Epistaxis 17 1 22 0.3
Renal
Proteinuria5 16 3 15 3
* Graded per NCI CTCAE v4.0
1 Includes neuropathy peripheral, peripheral sensory neuropathy, hypoesthesia, paraesthesia, dysesthesia, polyneuropathy.
2 Includes rash, rash maculo-papular, drug eruption, eczema, eczema asteatotic, dermatitis, contact dermatitis, rash erythematous, rash macular, pruritic rash, seborrheic dermatitis, dermatitis psoriasiform.
3 Includes pain in extremity, musculoskeletal chest pain, musculoskeletal discomfort, neck pain, backpain, myalgia, and bone pain.
4 Includes diarrhea, gastroenteritis, colitis, enterocolitis.
5 Data based on Preferred Terms since laboratory data for proteinuria were not systematically collected.

Table 7: Laboratory Abnormalities Worsening from Baseline Occurring in ≥20% of Patients with NSCLC Receiving TECENTRIQ in IMpower150

Laboratory Abnormality TECENTRIQ with Bevacizumab, Paclitaxel, and Carboplatin Bevacizumab, Paclitaxel and Carboplatin
All Grades (%) Grades 3-4 (%) All Grades (%) Grades 3-4 (%)
Hematology
Anemia 83 10 83 9
Neutropenia 52 31 45 26
Lymphopenia 48 17 38 13
Chemistry
Hyperglycemia 61 0 60 0
Increased BUN 52 NA1 44 NA1
Hypomagnesemia 42 2 36 1
Hypoalbuminemia 40 3 31 2
Increased AST 40 4 28 0.8
Hyponatremia 38 10 36 9
Increased Alkaline Phosphatase 37 2 32 1
Increased ALT 37 6 28 0.5
Increased TSH 30 NA1 20 NA1
Hyperkalemia 28 3 25 2
Increased Creatinine 28 1 19 2
Hypocalcemia 26 3 21 3
Hypophosphatemia 25 4 18 4
Hypokalemia 23 7 14 4
Hyperphosphatemia 25 NA1 19 NA1
Each test incidence is based on the number of patients who had both baseline and at least one on-study laboratory measurement available: TECENTRIQ with bevacizumab, paclitaxel, and carboplatin range: 337-380); bevacizumab, paclitaxel, and carboplatin (range: 337-382). Graded per NCI CTCAE v4.0
1 NA = Not applicable. NCI CTCAE does not provide a Grades 3-4 definition for these laboratory abnormalities

IMpower130

The safety of TECENTRIQ with paclitaxel protein-bound and carboplatin was evaluated in IMpower130, a multicenter, international, randomized, open-label trial in which 473 chemotherapy-naive patients with metastatic non-squamous NSCLC received TECENTRIQ 1200 mg and carboplatin AUC 6 mg/mL/min intravenously on Day 1 and paclitaxel protein-bound 100 mg/m² intravenously on Day 1, 8, and 15 of each 21-day cycle for a maximum of 4 or 6 cycles, followed by TECENTRIQ 1200 mg intravenously every 3 weeks until disease progression or unacceptability toxicity [see Clinical Studies]. Among patients receiving TECENTRIQ, 55% were exposed for 6 months or longer and 3.5% were exposed for greater than one year.

Fatal adverse reactions occurred in 5.3% of patients receiving TECENTRIQ; these included including pneumonia (1.1%), pulmonary embolism (0.8%), myocardial infarction (0.6%), cardiac arrest (0.4%) and pneumonitis (0.4%) and sepsis, septic shock, staphylococcal sepsis, aspiration, respiratory distress, cardiorespiratory arrest, ventricular tachycardia, death (not otherwise specified), and hepatic cirrhosis (0.2% each).

Serious adverse reactions occurred in 51% of patients receiving TECENTRIQ. The most frequent serious adverse reactions (≥2%) were pneumonia (6%), diarrhea (3%), lung infection (3.0%), pulmonary embolism (3%), chronic obstructive pulmonary disease exacerbation (2.5%), dyspnea (2.3%), and febrile neutropenia (1.9%).

TECENTRIQ was discontinued due to adverse reactions in 13% of patients; the most common adverse reactions leading to discontinuation were pneumonia (0.8%), pulmonary embolism (0.8%), fatigue (0.6%), dyspnea (0.6%), pneumonitis (0.6%), neutropenia (0.4%), nausea (0.4%), renal failure (0.4%), cardiac arrest (0.4%), and septic shock (0.4%).

Adverse reactions leading to interruption of TECENTRIQ occurred in 62% of patients; the most common (>1%) were neutropenia, thrombocytopenia, anemia, diarrhea, fatigue/asthenia, pneumonia, dyspnea, pneumonitis, pyrexia, nausea, acute kidney injury, vomiting, pulmonary embolism, arthralgia, infusion-related reaction, abdominal pain, chronic obstructive pulmonary disease exacerbation, dehydration, and hypokalemia.

Tables 8 and 9 summarize adverse reactions and laboratory abnormalities in patients receiving TECENTRIQ with paclitaxel protein-bound and carboplatin in IMpower130.

Table 8: Adverse Reactions Occurring in ≥20% of Patients with NSCLC Receiving TECENTRIQ in IMpower130

Adverse Reaction TECENTRIQ with Paclitaxel Protein-Bound and Carboplatin
(n=473)
Paclitaxel Protein-Bound and Carboplatin
(n=232)
All Grades (%) Grades 3-4 (%) All Grades (%) Grades 3-4 (%)
General
Fatigue/Asthenia 61 11 60 8
Gastrointestinal
Nausea 50 3.4 46 2.2
Diarrhea 1 43 6 32 6
Constipation 36 1.1 31 0
Vomiting 27 2.7 19 2.2
Musculoskeletal and Connective Tissue
Myalgia/Pain 2 38 3 22 0.4
Nervous System
Neuropathy 3 33 2.5 28 2.2
Respiratory, Thoracic and Mediastinal
Dyspnea 4 32 4.9 25 1.3
Cough 27 0.6 17 0
Skin and Subcutaneous Tissue
Alopecia 32 0 27 0
Rash 5 20 0.6 11 0.9
Metabolism and Nutrition
Decreased appetite 30 2.1 26 2.2
Graded per NCI CTCAE v4.0
1 Includes diarrhea, colitis, and gastroenteritis
2 Includes back pain, pain in extremity, myalgia, musculoskeletal chest pain, bone pain, neck pain and musculoskeletal discomfort
3 Includes neuropathy peripheral, peripheral sensory neuropathy, hypoesthesia, paresthesia, dysesthesia, polyneuropathy
4 Includes dyspnea, dyspnea exertional and wheezing
5 Includes rash, rash maculo-papular, eczema, rash pruritic, rash erythematous, dermatitis, dermatitis contact, drug eruption, seborrheic dermatitis and rash macular.

Table 9: Laboratory Abnormalities Worsening from Baseline Occurring in ≥20% of Patients Receiving TECENTRIQ in IMpower130

Laboratory Abnormality TECENTRIQ with Paclitaxel Protein-Bound and Carboplatin
(n=473)
Paclitaxel Protein-Bound and Carboplatin
(n=232)
All Grades (%) Grades 3-4 (%) All Grades (%) Grades 3-4 (%)
Hematology
Anemia 92 33 87 25
Neutropenia 75 50 67 39
Thrombocytopenia 73 19 59 13
Lymphopenia 71 23 61 16
Chemistry
Hyperglycemia 75 8 66 8
Hypomagnesemia 50 3.4 42 3.2
Hyponatremia 37 9 28 7
Hypoalbuminemia 35 1.3 31 0
Increased ALT 31 2.8 24 3.9
Hypocalcemia 31 2.6 27 1.8
Hypophosphatemia 29 6 20 3.2
Increased AST 28 2.2 24 1.8
Increased TSH 26 NA1 5 NA1
Hypokalemia 26 6 24 4.4
Increased Alkaline Phosphatase 25 2.6 22 1.3
Increased Blood Creatinine 23 2.8 16 0.4
Hyperphosphatemia 21 NA1 13 NA1
Each test incidence is based on the number of patients who had both baseline and at least one on-study laboratory measurement available: TECENTRIQ with paclitaxel protein bound and carboplatin (range: 423 -467); paclitaxel protein bound and carboplatin (range: 218-229). Graded per NCI CTCAE v4.0.
1 NA = Not applicable. NCI CTCAE does not provide a Grades 3-4 definition for these laboratory abnormalities

Previously Treated Metastatic NSCLC

The safety of TECENTRIQ was evaluated in OAK, a multicenter, international, randomized, open-label trial in patients with metastatic NSCLC who progressed during or following a platinum-containing regimen, regardless of PD-L1 expression [see Clinical Studies].A total of 609 patients received TECENTRIQ 1200 mg intravenously every 3 weeks until unacceptable toxicity, radiographic progression, or clinical progression or docetaxel (n=578) 75 mg/m² intravenously every 3 weeks until unacceptable toxicity or disease progression. The study excluded patients with active or prior autoimmune disease or with medical conditions that required systemic corticosteroids. The median duration of exposure was 3.4 months (0 to 26 months) in TECENTRIQ-treated patients and 2.1 months (0 to 23 months) in docetaxel-treated patients.

The study population characteristics were: median age of 63 years (25 to 85 years), 46% age 65 years or older, 62% male, 71% White, 20% Asian, 68% former smoker, 16% current smoker, and 63% had ECOG performance status of 1.

Fatal adverse reactions occurred in 1.6% of patients; these included pneumonia, sepsis, septic shock, dyspnea, pulmonary hemorrhage, sudden death, myocardial ischemia or renal failure.

Serious adverse reactions occurred in 33.5% of patients. The most frequent serious adverse reactions (>1%) were pneumonia, sepsis, dyspnea, pleural effusion, pulmonary embolism, pyrexia and respiratory tract infection.

TECENTRIQ was discontinued due to adverse reactions in 8% of patients. The most common adverse reactions leading to TECENTRIQ discontinuation were fatigue, infections and dyspnea. Adverse reactions leading to interruption of TECENTRIQ occurred in 25% of patients; the most common (>1%) were pneumonia, liver function test abnormality, dyspnea, fatigue, pyrexia, and back pain.

Tables 10 and 11 summarize adverse reactions and laboratory abnormalities, respectively, in OAK.

Table 10: Adverse Reactions Occurring in ≥10% of Patients with NSCLC Receiving TECENTRIQ in OAK

Adverse Reaction1 TECENTRIQ
N = 609
Docetaxel
N = 578
All Grades (%) Grades 3-4 (%) All Grades (%) Grades 3-4 (%)
General
Fatigue/Asthenia2 44 4 53 6
Pyrexia 18 <1 13 <1
Respiratory
Cough3 26 <1 21 <1
Dyspnea 22 2.8 21 2.6
Metabolism and Nutrition
Decreased appetite 23 <1 24 1.6
Musculoskeletal
Myalgia/pain4 20 1.3 20 <1
Arthralgia 12 0.5 10 0.2
Gastrointestinal
Nausea 18 <1 23 <1
Constipation 18 <1 14 <1
Diarrhea 16 <1 24 2
Skin
Rash5 12 <1 10 0
1 Graded per NCI CTCAE v4.0
2 Includes fatigue and asthenia
3 Includes cough and exertional cough
4 Includes musculoskeletal pain, musculoskeletal stiffness, musculoskeletal chest pain, myalgia
5 Includes rash, erythematous rash, generalized rash, maculopapular rash, papular rash, pruritic rash, pustular rash, pemphigoid

Table 11: Laboratory Abnormalities Worsening From Baseline Occurring in ≥20% of Patients with NSCLC Receiving TECENTRIQ in OAK

Laboratory Abnormality TECENTRIQ Docetaxel
All Grades (%) Grades 3-4 (%) All Grades (%) Grades 3-4 (%)
Hematology
Anemia 67 3 82 7
Lymphocytopenia 49 14 60 21
Chemistry
Hypoalbuminemia 48 4 50 3
Hyponatremia 42 7 31 6
Increased Alkaline Phosphatase 39 2 25 1
Increased AST 31 3 16 0.5
Increased ALT 27 3 14 0.5
Hypophosphatemia 27 5 23 4
Hypomagnesemia 26 1 21 1
Increased Creatinine 23 2 16 1
Each test incidence is based on the number of patients who had both baseline and at least one on-study laboratory measurement available: TECENTRIQ (range: 546-585) and docetaxel (range: 532-560). Graded according to NCI CTCAE version 4.0

Metastatic Triple Negative Breast Cancer (TNBC)

The safety of TECENTRIQ in combination with paclitaxel protein-bound was evaluated in IMpassion130, a multicenter, international, randomized, double-blinded placebo-controlled trial in patients with locally advanced or metastatic TNBC who have not received prior chemotherapy for metastatic disease [see Clinical Studies]. Patients received TECENTRIQ 840 mg (n=452) or placebo (n=438) intravenously followed by paclitaxel protein-bound (100 mg/m²) intravenously. For each 28 day cycle, TECENTRIQ was administered on days 1 and 15 and paclitaxel protein-bound was administered on days 1, 8, and 15 until disease progression or unacceptable toxicity. In the safety-evaluable population, the median duration of exposure to TECENTRIQ was 5.5 months (range: 0-32 months) and paclitaxel protein-bound was 5.1 months (range: 0-31.5 months) in the TECENTRIQ plus paclitaxel protein-bound arm. The median duration of exposure to placebo was 5.1 months (range: 0-25.1 months) and paclitaxel protein-bound was 5.0 months (range: 0-23.7 months) in the placebo plus paclitaxel protein-bound arm.

Fatal adverse reactions occurred in 1.3%) of patients in the TECENTRIQ and paclitaxel protein-bound arm; these included septic shock, mucosal inflammation, auto-immune hepatitis, aspiration, pneumonia, pulmonary embolism.

Serious adverse reactions occurred in 23% of patients. The most frequent serious adverse reactions were pneumonia (2%), urinary tract infection (1%), dyspnea (1%), and pyrexia (1%).

Adverse reactions leading to discontinuation of TECENTRIQ occurred in 6% (29/452) of patients in the TECENTRIQ and paclitaxel protein-bound arm. The most common adverse reaction leading to TECENTRIQ discontinuation was peripheral neuropathy (<1%).

Adverse reactions leading to interruption of TECENTRIQ occurred in 31% of patients; the most common (≥ 2%) were neutropenia, neutrophil count decreased, hyperthyroidism, and pyrexia.

Immune-related adverse reactions requiring systemic corticosteroid therapy occurred in 13% (59/452) of patients in the TECENTRIQ and paclitaxel protein-bound arm.

Tables 12 and 13 summarize adverse reactions and selected laboratory abnormalities worsening from baseline in the TECENTRIQ treated patients.

Table 12: Adverse Reactions Occurring in ≥10% of Patients with TNBC in IMpassion130

Adverse Reaction1 TECENTRIQ with Paclitaxel Protein-Bound
(n=452)
Placebo with Paclitaxel Protein-Bound
(n=438)
All Grades (%) Grades 3-4 (%) All Grades (%) Grades 3-4 (%)
Skin and Subcutaneous Tissue
Alopecia 56 <1 58 <1
Rash 17 <1 16 <1
Pruritus 14 0 10 0
Nervous System
Peripheral neuropathies2 47 9 44 5
Headache 23 <1 22 <1
Dysgeusia 14 0 14 0
Dizziness 14 0 11 0
General
Fatigue 47 4 45 3.4
Pyrexia 19 <1 11 0
Peripheral Edema 15 <1 16 1.4
Asthenia 12 <1 11 <1
Gastrointestinal
Nausea 46 1.1 38 1.8
Diarrhea 33 1.3 34 2.1
Constipation 25 <1 25 <1
Vomiting 20 <1 17 1.1
Abdominal pain 10 <1 12 <1
Respiratory, Thoracic, and Mediastinal
Cough 25 0 19 0
Dyspnea 16 <1 15 <1
Metabolism and Nutrition
Decreased Appetite 20 <1 18 <1
Musculoskeletal and Connective Tissue
Arthralgia 18 <1 16 <1
Back pain 15 1.3 13 <1
Myalgia 14 <1 15 <1
Pain in extremity 11 <1 10 <1
Endocrine
Hypothyroidism 14 0 3.4 0
Infections
Urinary tract infection 12 <1 11 <1
Upper respiratory tract infection 11 1.1 9 0
Nasopharyngitis 11 0 8 0
1 Graded per NCI CTCAE v4.0
2 Includes peripheral neuropathy, peripheral sensory neuropathy, paresthesia, and polyneuropathy

Table 13: Laboratory Abnormalities Worsening from Baseline Occurring in ≥20% of Patients with TNBC in IMpassion130

Laboratory Abnormality TECENTRIQ with Paclitaxel Protein-Bound
(n=452)
Placebo in combination with Paclitaxel Protein-Bound
(n=438)
All Grades1 (%)2 Grades 3-4 (%) All Grades1 (%)2 Grades 3-4 (%)
Hematology
Decreased Hemoglobin 79 3.8 73 3
Decreased Leukocytes 76 14 71 9
Decreased Neutrophils 58 13 54 13
Decreased Lymphocytes 54 13 47 8
Increased Prothrombin INR 25 <1 25 <1
Chemistry
Increased ALT 43 6 34 2.7
Increased AST 42 4.9 34 3.4
Decreased Calcium 28 1.1 26 <1
Decreased Sodium 27 4.2 25 2.7
Decreased Albumin 27 <1 25 <1
Increased Alkaline Phosphatase 25 3.3 22 2.7
Decreased Phosphate 22 3.6 19 3.7
Increased Creatinine 21 <1 16 <1
1 Graded per NCI CTCAE v4.0, except for increased creatinine which only includes patients with creatinine increase based on upper limit of normal definition for grade 1 events (NCI CTCAE v5.0).
2 Based on the number of patients with available baseline and at least one on-treatment laboratory test.

Small Cell Lung Cancer (SCLC)

The safety of TECENTRIQ with carboplatin and etoposide was evaluated in IMpower133, a randomized, multicenter, double-blind, placebo-controlled trial in which 198 patients with ESSCLC received TECENTRIQ 1200 mg and carboplatin AUC 5 mg/mL/min on Day 1 and etoposide 100 mg/m² intravenously on Days 1, 2 and 3 of each 21-day cycle for a maximum of 4 cycles, followed by TECENTRIQ 1200 mg every 3 weeks until disease progression or unacceptable toxicity [see Clinical Studies]. Among 198 patients receiving TECENTRIQ, 32% were exposed for 6 months or longer and 12% were exposed for 12 months or longer.

Fatal adverse reactions occurred in 2% of patients receiving TECENTRIQ. These included pneumonia, respiratory failure, neutropenia, and death (1 patient each).

Serious adverse reactions occurred in 37% of patients receiving TECENTRIQ. Serious adverse reactions in >2% were pneumonia (4.5%), neutropenia (3.5%), febrile neutropenia (2.5%), and thrombocytopenia (2.5%).

TECENTRIQ was discontinued due to adverse reactions in 11% of patients. The most frequent adverse reaction requiring permanent discontinuation in >2% of patients was infusion-related reactions (2.5%).

Adverse reactions leading to interruption of TECENTRIQ occurred in 59% of patients; the most common (>1%) were neutropenia (22%), anemia (9%), leukopenia (7%), thrombocytopenia (5%), fatigue (4.0%), infusion-related reaction (3.5%), pneumonia (2.0%), febrile neutropenia (1.5%), increased ALT (1.5%), and nausea (1.5%).

Tables 14 and 15 summarize adverse reactions and laboratory abnormalities, respectively, in patients who received TECENTRIQ with carboplatin and etoposide in IMpower133.

Table 14: Adverse Reactions Occurring in ≥20% of Patients with SCLC Receiving TECENTRIQ in IMpower133

Adverse Reaction TECENTRIQ with Carboplatin and Etoposide
N = 198
Placebo with Carboplatin and Etoposide
N = 196
All Grades1 (%) Grades 3-41 (%) All Grades1 (%) Grades 3-41 (%)
General
Fatigue/asthenia 39 5 33 3
Gastrointestinal
Nausea 38 1 33 1
Constipation 26 1 30 1
Vomiting 20 2 17 3
Skin and Subcutaneous Tissue
Alopecia 37 0 35 0
Metabolism and Nutrition
Decreased appetite 27 1 18 0
1 Graded per NCI CTCAE v4.0

Table 15: Laboratory Abnormalities Worsening from Baseline Occurring in ≥20% of Patients with SCLC Receiving TECENTRIQ in IMpower133

Laboratory Abnormality TECENTRIQ with Carboplatin and Etoposide Placebo with Carboplatin and Etoposide
All Grades (%) Grades 3-4 (%) All Grades (%) Grades 3-4 (%)
Hematology
Anemia 94 17 93 19
Neutropenia 73 45 76 48
Thrombocytopenia 58 20 53 17
Lymphopenia 46 14 38 11
Chemistry
Hyperglycemia 67 10 65 8
Increased Alkaline Phosphatase 38 1 35 2
Hyponatremia 34 15 33 11
Hypoalbuminemia 32 1 30 0
Decreased TSH3 28 NA1 15 NA1
Hypomagnesemia 31 5 35 6
Hypocalcemia 26 3 28 5
Increased ALT 26 3 31 1
Increased AST 22 1 21 2
Increased Blood Creatinine 22 4 15 1
Hyperphosphatemia3 21 NA1 23 NA1
Increased TSH3 21 NA1 7 NA1
Each test incidence is based on the number of patients who had both baseline and at least one on-study laboratory measurement available: TECENTRIQ (range: 181-193); Placebo (range: 181-196). Graded per NCI CTCAE v4.0
1 NA= Not applicable. NCI CTCAE v4.0 does not include these laboratories.

Immunogenicity

As with all therapeutic proteins, there is a potential for immunogenicity. The detection of antibody formation is highly dependent on the sensitivity and specificity of the assay. Additionally, the observed incidence of antibody (including neutralizing antibody) positivity in an assay may be influenced by several factors including assay methodology, sample handling, timing of sample collection, concomitant medications, and underlying disease. For these reasons, comparison of the incidence of antibodies to atezolizumab in the studies described above with the incidence of antibodies in other studies or to other products may be misleading.

Among 565 patients with NSCLC in OAK, 30% tested positive for treatment-emergent anti-drug antibodies (ADA) at one or more post-dose time points. The median onset time to ADA formation was 3 weeks. The ability of these binding ADA to neutralize atezolizumab is unknown. Patients who tested positive for treatment-emergent ADA also had decreased systemic atezolizumab exposure [see CLINICAL PHARMACOLOGY]. Exploratory analyses showed that the subset of patients who were ADA positive by week 4 (21%; 118/560) appeared to have less efficacy (effect on overall survival) as compared to patients who tested negative for treatment-emergent ADA by week 4 [see Clinical Studies]. The presence of ADA did not have a clinically significant effect on the incidence or severity of adverse reactions.

Among 275 patients with urothelial carcinoma in IMvigor210 (Cohort 2), 42% tested positive for treatment-emergent ADA at one or more post-dose time points. Among 111 patients in IMvigor210 (Cohort 1), 48% tested positive for treatment-emergent ADA at one or more post-dose time points. Patients who tested positive for treatment-emergent ADA also had decreased systemic atezolizumab exposures. The presence of ADA did not have a clinically significant effect on the incidence or severity of adverse reactions.

Among 364 ADA-evaluable patients with NSCLC who received TECENTRIQ with bevacizumab, paclitaxel and carboplatin in IMpower150, 36% (n=132) tested positive for treatment-emergent ADA at one or more post-dose time points and 83% of these 132 patients tested ADA positive prior to receiving the second dose of atezolizumab. The ability of these binding ADA to neutralize atezolizumab is unknown. Patients who tested positive for treatment-emergent ADA had lower systemic atezolizumab exposure as compared to patients who were ADA negative [see CLINICAL PHARMACOLOGY]. The presence of ADA did not increase the incidence or severity of adverse reactions [see Clinical Studies].

Among 434 patients with TNBC in IMpassion130, 13% tested positive for treatment-emergent ADA at one or more post-dose time points. Among 178 patients in PD-L1 positive subgroup with TNBC in IMpassion130, 12% tested positive for treatment-emergent ADA at one or more post-dose time points. Patients who tested positive for treatment-emergent ADA had decreased systemic atezolizumab exposure [see CLINICAL PHARMACOLOGY]. There are insufficient numbers of patients in the PD-L1 positive subgroup with ADA to determine whether ADA alters the efficacy of atezolizumab. The presence of ADA did not have a clinically significant effect on the incidence or severity of adverse reactions.

Read the entire FDA prescribing information for Tecentriq (Atezolizumab Injection)

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