Atezolizumab

Atezolizumab belongs to monoclonal antibodies used in the treatment of non-small cell lung cancer and metastatic breast cancer. Atezolizumab is given as an injection into veins under the supervision of a doctor. Your doctor will decide what dose is necessary and how often you need to take it. This will depend on what you are being treated for and may change from time to time. You should take it exactly as your doctor has advised. Taking it in the wrong way or taking too much can cause very serious side effects. It may take several weeks or months for you to see or feel the benefits but do not stop taking it unless your doctor tells you to. The most common side effects of this medicine include fatigue, nausea, constipation, and shortness of breath. Some test might required immediate action such as chest pain, loss of appetite, and dark urine. Inform your doctor if it bothers you, as there may be a way to prevent the side effects. Before taking it, tell your doctor if have heart disease, liver, or kidney problems or are taking any medicines to treat infections. Many other medicines can affect, or be affected by, this medicine so let your healthcare team know all medications you are using. This medicine is not recommended during pregnancy or while breastfeeding. Use of effective contraception by both males and females during treatment is important to avoid pregnancy. Atezolizumab is a type of monoclonal antibody. It works by blocking the activity of a protein located on the T cells- a type of white blood cells that regulate the functioning of the immune system. In the presence of Atezolizumab, the killing power of T-cells is restored and the immune response is stimulated to locate and destroy cancer cells.

• Non-small cell lung cancer • Metastatic breast cancer

Monoclonal antibody to programmed cell death ligand-1 protein (PDL1); binding PDL1 blocks the interaction between PDL-1 and its ligands (including B7.1 receptors) PDL-1 PDL1 is expressed on the surface of activated T cells under normal conditions; binding PDL1 inhibits immune activation and reduces T-cell cytotoxic activity when bound This negative feedback loop is essential for maintaining normal immune responses and limits T-cell activity to protect normal cells during chronic inflammation Tumor cells may circumvent T-cell–mediated cytotoxicity by expressing PDL1 on the tumor itself or on tumor-infiltrating immune cells, resulting in the inhibition of immune-mediated killing of tumor cells

Adult Dose: General: Atezolizumab must be administered as an intravenous (IV) infusion under the supervision of a qualified healthcare professional. Do not administer as an IV push or bolus. Substitution by any other biological medicinal product requires the consent of the prescribing physician. The recommended dose is 1200 mg administered by IV infusion every three weeks. The initial dose of Atezolizumab must be administered over 60 minutes. If the first infusion is tolerated, all subsequent infusions may be administered over 30 minutes. Duration of treatment: Patients are treated with Atezolizumab until loss of clinical benefit or unmanageable toxicity. Hepatic impairment: Based on a population pharmacokinetic analysis, no dose adjustment is required for patients with mild hepatic impairment. There are no data in patients with moderate or severe hepatic impairment Renal Dose: Renal impairment: Based on a population pharmacokinetic analysis, no dose adjustment is required in patients with renal impairment

Your doctor or nurse will give you this medicine. Kindly do not self-administer.

Common: • Fatigue • Nausea • Constipation • Cough • Breathlessness • Decreased appetite

[CONSULT YOUR DOCTOR] It is not known whether Atezolizumab alters the ability to drive. Do not drive if you experience any symptoms that affect your ability to concentrate and react. It is given as IV infusion under the supervision of a doctor. Don't drive or do anything that requires mental focus until you know how Atezolizumab affects you. Inform your doctor if you notice shortness of breath, chest pain, loss of appetite, and dark urine while taking this medicine. Do not stop taking the medicine without your doctor consultation.

Atezolizumabis contraindicated in patients with a known hypersensitivity to atezolizumab or any of the excipients.

[CONSULT YOUR DOCTOR] It is not known whether it is safe to consume alcohol with Atezolizumab. Please consult your doctor.

[CONSULT YOUR DOCTOR] Atezolizumab may be unsafe to use during pregnancy. Although there are limited studies in humans, animal studies have shown harmful effects on the developing baby. Your doctor will weigh the benefits and any potential risks before prescribing it to you. Please consult your doctor.

[CONSULT YOUR DOCTOR] Atezolizumab is probably unsafe to use during breastfeeding. Limited human data suggests that the drug may pass into the breastmilk and harm the baby.

[CONSULT YOUR DOCTOR] There is limited information available on the use of Atezolizumab in patients with kidney disease. Please consult your doctor. [CONSULT YOUR DOCTOR] There is limited information available on the use of Atezolizumab in patients with liver disease. Please consult your doctor.