Reviewed by: HU Medical Review Board | Last reviewed: February, 2022. | Last updated: July 2022
How does Avelumab work?
Avelumab can be described as an “immune checkpoint inhibitor” or “anti-PD-L1 therapy.” It is thought to work in two ways. First, Avelumab prevents cancer cells from hiding from your immune system’s T-cells. Second, it is thought to attract your body’s defense cells to destroy the cancer cell.
Prevents cancer cells from hiding
T-cells (T-lymphocytes) are a type of white blood cell.2 T-cells fight cancer and infection. They travel through the body, checking whether the cells they find are normal (healthy) or foreign (unhealthy). Receptors on the outside surface, called PD-1 and B7.1, do the checking. PD-1 stands for “programmed death receptor-1.”
Cancer cells try to hide from T-cells. Some cancer cells have proteins called PD-L1 on their outside surface. PD-L1 stands for “programmed death ligand-1.” When PD-L1 binds (connects) to PD-1, it basically acts like an “off switch” for the T-cell. This makes the T-cell ignore the cancer cell.
Avelumab binds to PD-L1.1 This blocks PD-L1 from interacting with its receptors (PD-1 or B7.1), disabling the “off switch.” The T-cell is able to identify and attack the cancer cell.
Attracts defense cells to destroy the cancer cell
Foreign (unhealthy) cells have proteins, called antigens, on their cell surface. Your body responds to these foreign antigens by making antibodies. The antibodies do many things. One thing they do is activate your body’s defense cells, which work together to destroy the unhealthy cell.3
Laboratory studies have shown that Avelumab activates this system.1 Avelumab is a type of medication called an “IgG monoclonal antibody.” It may work by “flagging” the cancer cell as a target for your body’s natural defense cells.
Before receiving Avelumab, read the Medication Guide that comes in the package. Talk to your doctor about how often and how many treatments you will need.
Avelumab is taken through an intravenous (IV) line. Your doctor will arrange for you to be administered Avelumab.
What are the side effects of Avelumab?
The most common side effects of Avelumab in the treatment of Merkel cell carcinoma include:1
- Feeling tired
- Muscle and bone pain
- Swelling in your hands, feet, or ankles
- Loss of appetite
- Skin rash
- Reaction to the infusion
Avelumab can cause your immune system to attack normal (healthy) organs and tissue. Less common but serious possible side effects include:
- Lung inflammation (pneumonitis)
- Liver inflammation (hepatitis)
- Intestinal inflammation (colitis)
- Problems with hormone glands (thyroid, adrenal, pancreas)
- Kidney inflammation
- Other problems (severe muscle weakness, severe or lasting muscle or joint pain, chest pain or tightness, trouble breathing, skin reaction, changes in heartbeat, tiredness, swelling of the feet and legs, dizziness or fainting, fever, flu-like symptoms, changes in eyesight)
Avelumab is infused (put) into your vein through an IV line. Severe, life-threatening infusion reactions can occur. Symptoms include chills, shaking, hives, flushing, shortness of breath, wheezing, low blood pressure, fever, back pain, or abdominal pain.1
This is not an exhaustive list of all potential side effects of Avelumab. Talk to your healthcare provider or pharmacist for further information.
Who should not take Avelumab?
If you are pregnant, plan to become pregnant, or are breastfeeding or plan to breastfeed, talk with your doctor. Avelumab can cause harm to a developing fetus and should not be given to women who are pregnant. While receiving avelumab, females who can become pregnant should use contraceptives during treatment and for a period of time after completing treatment (patients should discuss appropriate birth control methods, and how long they need to use them, with their doctor). Females should not breastfeed during Avelumab treatment and for a period of time following the final dose (patients should discuss breastfeeding considerations with their doctor).
Tell your doctor about any medical conditions you have, especially:
- Immune system problems (such as Crohn’s disease, ulcerative colitis, lupus).
- Previous organ transplant.
- Lung or breathing problems.
- Liver or kidney problems.
What precautions are needed when taking Avelumab?
You will need regular blood tests to check for side effects of Avelumab. Your doctor may prescribe corticosteroids or hormone replacement medicines to treat certain side effects.1
Before starting treatment with Avelumab, patients should tell their doctor about all medications (prescription and over-the-counter), herbal supplements, and vitamins they are taking. Patients should talk to their doctor if they have any questions, or if they have questions regarding their Avelumab regimen.