Information leaflet on Atezolizumab and Bevacizumab
This leaflet provides information for patients having treatment with Atezolizumab and Bevacizumab. The leaflet will explain what Atezolizumab and Bevacizumab is and when and how it is given. It will also tell you about common side effects that you may experience. Contact telephone numbers and details of how to obtain further information on Atezolizumab and Bevacizumab are given at the end of the leaflet.
Your ‘specialist team’ refers to your oncology team at Velindre Cancer Centre which includes doctors, specialist nurses and nurse or pharmacy prescribers.
What is Atezolizumab and Bevacizumab and why am I having it?
Atezolizumab is a treatment which helps your immune system to attack and destroy cancer cells. Atezolizumab is used to treat your type of cancer, but it is not a chemotherapy drug, it is immunotherapy.
Bevacizumab is an artificially made anti-body which attaches itself to cancer cells and stops them from growing. It is not chemotherapy.
Atezolizumab is given by subcutaneous injection under the skin on your thigh.
Bevacizumab is given in a drip.
How often will I receive Atezolizumab and Bevacizumab?
For this treatment to be most effective, it is given at specific time intervals. These are known as cycles.
For your particular treatment it is usual to have Atezolizumab and bevacizumab every 3 weeks.
Your specialist team will discuss how often you will receive your treatment with you and how long you will have to continue having the treatment.
How often will I see the specialist team?
You will need to be reviewed regularly whilst having this treatment. This will either be face to face in an outpatient clinic or a telephone consultation. The specialist team who prescribe your treatment will check how you are feeling and discuss any problems you may have.
You will also have regular blood tests. This is so we can check how the treatment is affecting you. If your blood results are satisfactory, your treatment will be given.
How is Bevacizumab given?
Bevacizumab is given through a drip into a vein in the back of your hand or arm. Alternatively it may be suggested that a fine tube called a PICC is inserted into a large vein in your upper arm. This will remain in place throughout the course of your treatment. Your doctor or nurse will discuss this further with you, if required, and we have a leaflet that tells you more about PICC lines.
The administration of Atezolizumab by subcutaneous injection will take approx. 7 minutes. The injection site will change from your left to right thigh each treatment cycle. In order for the Nurse to give the injection into your leg it is advisable to wear comfortable loose-fitting clothing, for example a skirt or trousers, to enable access to your thigh for administration on the day of your treatment
Where will my treatment be given?
The treatments will be given in the day case treatment areas at Velindre Cancer Centre or in one of the Velindre Cancer Centre outreach clinics
How long will I be in the hospital?
It will take approximately 2 and a half hours for your Atezolizumab and Bevacizumab appointment. Please allow extra time for your first 2 appointments. This is because we give the bevacizumab over a longer time to make sure you are OK.
Can I bring relatives and friends with me?
You are welcome to bring someone to stay with you during your treatment. Space is limited so there is not usually room for more than one person. Treatment areas are not suitable for young children.
Reactions during the treatment
If you experience any of the following during the treatment please tell your nurse straight away:
If any of these occur we will slow down or stop the Bevacizumab until you feel better. We may need to give you medication to help to settle the sensitivity reaction. The bevacizumab can usually start again, and usually without any further problems.
What are the possible side effects?
Some people have very few side effects whilst others may experience more.
You may have injection site reactions. It is usually mild and around the injection site there may be pain, red skin or rash.
Some of the side effects happen because Atezolizumab affects the immune system causing inflammation of other parts of the body such as the skin, the bowels and hormone producing glands. Most, if not all severe side effects can be controlled by the use of steroid medication immediately either as tablets or through a drip. Hospital admission may become necessary, however, for severe immune related reactions.
It is important that if you have more severe side effects that you contact Velindre Cancer Centre. The telephone number is at the end of the leaflet. Further details of when to contact Velindre are included in the individual side effects listed below.
If you are admitted to another hospital, you must inform the doctors and the nurses that you are taking Atezolizumab and Bevacizumab. It is possible you could be having an immune reaction and should be started on steroids. The doctors and nurses need to contact Velindre Cancer Centre for advice. They can either telephone the treatment helpline or speak to your oncologist.
You will be given an alert card, please show this to the nurses or doctors if you are admitted to any hospital.
Flu-like symptoms/Chills/ Infection
You may experience flu-like symptoms and chills. However, if you have signs of infection, such as cough, cold, passing urine more frequently or stinging or coughing up green phlegm, ring Velindre cancer centre on the telephone at the end of the leaflet.
If you develop an infection whilst your white blood cells are low, you are at risk of sepsis, this can be life threatening.
Contact Velindre Cancer Centre immediately if you develop any signs of infection, for example flu like symptoms or a temperature above 37.5°centigrade. The telephone number is at the end of the leaflet.
Hair loss
This treatment should not cause hair loss
Nausea and vomiting
Your treatment can cause nausea and vomiting. If you experience nausea, we can give you anti sickness medication to help. If the anti sickness medication does not help or you vomit, contact Velindre Cancer Centre for advice. The telephone number is at the end of the leaflet.
Effects on the bowels
This treatment has been known to cause diarrhoea.
If you experience diarrhoea it is important that you drink plenty of fluids. Medication is available to control diarrhoea. If you have 4 or more bowel movements in 24 hours above what is normal for you please contact Velindre Cancer Centre immediately. The telephone number is at the end of the leaflet.
Please note:
If you have any of the symptoms below you must inform Velindre Cancer Centre immediately, the telephone numbers are at the end of the leaflet.
There is a risk of inflammation of the bowel (colitis) or rupture of the bowel (perforation) in a small minority of patients. Therefore it is important to inform us of any of the above symptoms or abdominal pain or swelling.
Effects on the skin
You may develop an itching skin rash which can be treated with moisturising cream. However if you get a severe skin reaction you may need to be treated in hospital.
Please contact Velindre Cancer Centre if:
Effects on your hormone glands
Atezolizumab can cause inflammation of the glands that produce the different hormones (chemicals that control many of the body’s functions) in the body. Symptoms will vary depending on which glands are affected.
It is important to contact Velindre cancer Centre if you have the following :
Tiredness and fatigue
Your treatment can make you feel more tired than usual. It is important to listen to your body and rest if you need to, but carry out your normal activities if you feel able. Some people find it beneficial to take gentle exercise as well as taking rest. If you are sleeping more than 50% during the daytime you need to contact Velindre Cancer Centre on the number at the end of the leaflet
Myalgia (pain in the muscles)
Some patients may experience myalgia which is muscle or joint pain. If you already have painkillers at home you may find they relieve the pain. If this does not work please contact Velindre Cancer Centre. The telephone number is at the end of the leaflet.
High blood pressure
Bevacizumab can cause an increase in blood pressure in some people. Your blood pressure will be checked regularly during your treatment. If you have headaches, nosebleeds or feel dizzy let your doctor know. High blood pressure can usually be controlled with tablets prescribed by your doctor.
Protein in the urine
This can occur due to effects of bevacizumab on the kidneys. It doesn’t normally cause symptoms but requires careful monitoring. Before each dose of treatment you will have your urine tested for protein. If protein is identifies you may need to have a 24 hour urine collection to assess how well your kidneys are working. Bevacizumab may be stopped until the protein found in the urine has resolved.
Risk of bleeding
Your treatment may reduce the production of platelets (which help the blood to clot). This will increase your risk of bruising or bleeding. If you notice any excessive bruising on your body or bleeding such as nosebleeds or bleeding from your gums you should contact Velindre Cancer Centre for advice. The telephone number is at the end of the leaflet. Tell your team if you take medicines which may affect bleeding, such as aspirin, warfarin or vitamin E.
Effects on breathing:
If you experience shortness of breath, cough or any breathing difficulties it is important to inform the treatment helpline in Velindre cancer centre, on the telephone at the end of the leaflet. It is possible to develop a condition called pneumonitis, which can be life-threatening and needs to be treated.
Effects on the liver
This is rare, but if you are affected you may feel more tired than usual and may also feel sick or vomit. Your doctor will give you anti sickness medicine to take.
Please contact Velindre Cancer Centre if:
More severe effects on the liver are very rare but can be very serious so you should contact Velindre Cancer Centre if:
Other side effects:
You may have these additional side effects, if so please contact Velindre Cancer Centre:
Other information
It is important you do not become pregnant, breastfeed or father a child whilst having Atezolizumab and Bevacizumab treatment and for 6 months after treatment.
It is recommended not to have live vaccines whilst on Atezolizumab and Bevacizumab.
Inform your oncologist if you have any autoimmune diseases for example: Crohns, Ulcerative colitis, Lupus, Multiple sclerosis.
Inform your oncologist if you are on long term steroids.
Side effects may continue for up to 6 months after treatment. If you have any side effects contact your consultant. If you are admitted to hospital or see your GP during this period, inform the doctor you have had Atezolizumab, an immunotherapy medication, and show them your alert card.
Sometimes cancer drugs can have very serious side effects which can be life threatening. It is important to inform Velindre cancer centre if you are concerned about any side-effects.
A diagnosis of cancer can increase your risk of developing a blood clot (thrombosis), and having cancer treatment may increase this risk further. It is important to tell your doctor immediately if you have symptoms such as pain, redness and swelling in your leg, or breathlessness and chest pain.
Blood clots can be very serious. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information.
Manufacturer’s patient information leaflets
Velindre leaflets provide information about very common and common side-effects: for more information regarding the less common side-effects please refer to the manufacturers patient information leaflets, obtained from Velindre pharmacy and/or on the internet at www.medicines.org.uk. Sometimes patients may find these leaflets difficult to read however. Please ask if you would like a copy from your doctor or from
Contact telephone numbers
Velindre Cancer Centre 029 2061 5888
If you are unwell at home and need immediate attention at any time of the day or night ask for the treatment helpline
Pharmacy department 029 2061 5888 ext 6223
Monday – Friday 9am – 5pm for queries about your medicines
Tenovus freephone 0808 808 1010
cancer helpline
This leaflet was written by health professionals. The information contained in this leaflet is evidence based. The leaflet has been approved by doctors, nurses, pharmacists and patients. It is reviewed and updated every 2 years.
Prepared July 2020
Reviewed November 2023