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Bavencio (avelumab)

Bavencio® (avelumab) is a type of immunotherapy. It is used to treat Merkel cell carcinoma that has spread to distant parts of the body (metastasized).1

Avelumab does not come in generic form. Avelumab is also approved to treat certain types of bladder cancer.

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. They have proteins called PD-L1 on their outside surface. PD-LI 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.

How is Avelumab given?

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. Avelumab is usually given every 2 weeks. It takes about 60 minutes to administer the medication.

What are the side effects of Avelumab?

The most common side effects of Avelumab include:1

  • Feeling tired
  • Muscle and bone pain
  • Diarrhea
  • Nausea
  • Swelling in your hands, feet, or ankles
  • Loss of appetite
  • Skin rash

Avelumab can cause your immune system to attack normal (healthy) organs and tissue. Rare 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

Who should not take Avelumab?

Avelumab can harm an unborn baby.1 Women who could become pregnant should use birth control during treatment and for at least 1 month after the last dose of Avelumab. Do not breastfeed while taking Avelumab or for 1 month after the last dose.

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.
  • Diabetes.

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

During treatment and for at least 1 month after the last dose of Avelumab:1

  • Women who can become pregnant should use birth control.
  • Women should not breastfeed during treatment and for a month after treatment.
Written by: Sarah O'Brien | Last reviewed: June 2019.
  1. Bavencio® [prescribing information]. Whitehouse Station, NJ: Merck & Co, Inc; May 2017.
  2. PubMed Health. T-Lymphocytes (T-Cells). Accessed April 7, 2017 at: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022044/
  3. PubMed Health. The defense mechanism of the adaptive immune system. Accessed April 9, 2017 at: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072581/
  4. Kaufman HL, Russell J, Hamid O, et al. Avelumab in patients with chemotherapy-refractory metastatic Merkel cell carcinoma: a multicentre, single-group, open-label, phase 2 trial. Lancet Oncol. 2016;17:1374-1385.
  5. ClinicalTrials.gov. Avelumab in subjects with Merkel cell carcinoma (JAVELIN Merkel 200). NCT02155647. Accessed April 10, 2017 at: https://clinicaltrials.gov/ct2/show/NCT02155647.