Barw Barw Medical Journal 2960-1959 2026 08 22 Safety and Efficacy of Atezolizumab in Ovarian Cancer 10.58742/bmj.v4i2.238 eng Rebaz M. Ali Department of Oncology, Smart Hospital, Madam Mitterrand Street, Sulaymaniyah, Iraq . Rebazhaji@gmail.com Sami S. Omar Faculty of Medicine, Koya University, Koya City, Residency Road, Erbil, Iraq | Kscien Organization for Scientific Research (Middle East Office), Hamdi Street, Sulaymaniyah, Iraq. Samiomer@gmail.com Shano M. Ali Department of Oncology, Smart Hospital, Madam Mitterrand Street, Sulaymaniyah, Iraq. shanoali@gmail.com Shvan H. Mohammed Kscien Organization for Scientific Research (Middle East Office), Hamdi Street, Sulaymaniyah, Iraq. shvanmohammed@gmail.com Karokh K. Mohammed Smart Hospital (Raparin Branch), Karux Street, Ranya, Iraq. karokhmohammed@yahoo.com Mohammed Q. Mustafa Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary. mohammedq.mustafaa@gmail.com Yousif M. Mahmood Department of Administration, Smart Hospital, Madam Mitterrand Street, Sulaymaniyah, Iraq. YousifMahmood@gmail.com Suhaib H. Kakamad Department of Medical Laboratory Technology, Faculty of Health Sciences, Qaiwan International University, Sulaimaniyah, Iraq. Suhaibkakamad@gmail.com Hawkar A. Nasralla Department of Scientific Affairs, Smart Hospital, Madam Mitterrand Street, Sulaymaniyah, Iraq. hawkarnasralla@gmail.com Ahmed Gh. Hamasaeed Department of Pharmacy, Smart Hospital, Madam Mitterrand Street, Sulaymaniyah, Iraq | Department of Clinical Pharmacy, College of Pharmacy, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq. Ahmedhamasaeed@gmail.com Zheer T. Hamasalih Department of Scientific Affairs, Smart Hospital, Madam Mitterrand Street, Sulaymaniyah, Iraq. zhertofiq@gmail.com Danar D. Mahmood Department of Ward, Smart Hospital, Madam Mitterrand Street, Sulaymaniyah, Iraq. Danarmahmood@gmail.com Mohammed Jalal Mohammed Department of Pharmacy, Smart Hospital, Madam Mitterrand Street, Sulaymaniyah, Iraq. mohammedjalal@gmail.com Shahan Syamand Rasull Department of Pharmacy, Smart Hospital, Madam Mitterrand Street, Sulaymaniyah, Iraq. Shahansyamand@gmail.com Fryad Mustafa Qadir Department of Pharmacy, Smart Hospital, Madam Mitterrand Street, Sulaymaniyah, Iraq. fryadmustafa@gmail.com Berun A. Abdalla Kscien Organization for Scientific Research (Middle East Office), Hamdi Street, Sulaymaniyah, Iraq | Department of Scientific Affairs, Smart Hospital, Madam Mitterrand Street, Sulaymaniyah, Iraq. berun.anwer95@gmail.com 2026 07 01 Introduction Although the efficacy of PD-L1 blockade has been evaluated in analyses that combine pharmacologically distinct antibodies, the specific efficacy and safety of atezolizumab remain unclear. This review aimed to evaluate the efficacy and safety profile of atezolizumab specifically. Methods PubMed/MEDLINE and CENTRAL were searched (June 2026) for phase I to III trials of atezolizumab in ovarian cancer, reported in full-text English with at least 10 evaluable patients. Randomized and single-arm designs qualified. Randomized comparisons were pooled under random-effects models with Knapp-Hartung adjustment as hazard ratios for survival and risk ratios for response and safety; single-arm rates were pooled as proportions using generalized linear mixed models. Heterogeneity was assessed with I², Cochran Q, and prediction intervals, with leave-one-out sensitivity analysis. Analyses used R 4.6.0. Results Twelve studies (13 reports) enrolled 3,179 patients. Atezolizumab reduced the hazard of progression (HR 0.88, 95% CI 0.83 to 0.93) and death (HR 0.86, 95% CI 0.78 to 0.96), without heterogeneity (I² = 0%), whereas objective response was unchanged (RR 0.88, 95% CI 0.52 to 1.49). Excess toxicity was immune-mediated, raising serious adverse events (RR 1.32, 95% CI 1.05 to 1.67), any-grade immune-related events (RR 1.57, 95% CI 1.12 to 2.20), and grade ≥3 immune-related events (RR 2.23, 95% CI 1.05 to 4.74). Conclusion Atezolizumab adds a small survival benefit to a chemotherapy or bevacizumab backbone, driven by delayed progression rather than tumor regression. Offset by doubled immune toxicity and inseparable from its backbone, the effect may not justify routine use.