An introduction to Avelumab (Bavencio®) and its common usage and dosage.👀👀👀

Avelumab (Bavencio®): It is a Programmed Death Ligand 1 (PD-L1) inhibitor that was first approved by the FDA in 2017. Programmed Death Ligand 1 is expressed on tumor cells and immune cells infiltrating tumors. It suppresses anti-tumor immunity in the tumor microenvironment. PD-1 and B7.1 receptors on T cells and antigen-presenting cells bind to PD-L1. They inhibit cytotoxic T-cell activity, T-cell proliferation, and cytokine production. The binding of avelumab to PD-L1 will prevent PD-L1 from interacting with PD-1 and B7.1 receptors. Therefore, it can restore immune responses, including anti-tumor immune responses. In in vitro studies, avelumab induced antibody-dependent cell-mediated cytotoxicity (ADCC). Blocking PD-L1 activity has also been shown to reduce tumor growth in mouse tumor models.

Common Usage and Dosage of Avelumab:

Metastatic Merkel cell carcinoma(MCC): Avelumab can be used in patients 12 years of age and older with metastatic Merkel cell carcinoma. It is recommended for intravenous infusion of 800 mg every two weeks (infusion time is 60 minutes) until disease progression or unacceptable toxicity occurred.

Locally advanced or metastatic urothelial carcinoma (UC): Avelumab is indicated for the treatment of patients with locally advanced or metastatic urothelial carcinoma who have not progressed on first-line platinum-containing chemotherapy. It is also indicated for the treatment of patients with locally advanced or metastatic urothelial carcinoma whose disease has progressed during or after platinum-containing chemotherapy, and for patients with locally advanced or metastatic urothelial carcinoma whose disease has progressed within 12 months of neo-adjuvant or adjuvant treatment with platinum-containing chemotherapy. It is recommended for intravenous infusion of 800 mg every two weeks (infusion time is 60 minutes) until disease progression or unacceptable toxicity occurred.

Advanced Renal Cell Carcinoma (RCC): Avelumab can be used in combination with axitinib as a first-line treatment for patients with advanced RCC. It is recommended to be administered by intravenous infusion of 800 mg (infusion time is 60 minutes) every two weeks in combination with oral axitinib 5 mg (twice daily, 12 hours apart, with or without food) until disease progression or unacceptable toxicity occurred. When used in combination with axitinib, it may be considered to increase axitinib to above 5 mg every two weeks or longer intervals. However, before adjusting the dose, the relevant physiological indicators of axitinib should be reviewed. 

The recommended dose for children 12 years and older is the same as that for adults. However, the safety and efficacy of avelumab in patients younger than 12 years of age have not yet been established.

Administration of Avelumab:

Before the first four infusions of avelumab, patients were given antihistamines and acetaminophen. Subsequent Avelumab treatment requires prophylactic medication based on previous injection reactions, severity and clinical judgment.

Common adverse reactions:

• Gastrointestinal disorders: abdominal pain, constipation, diarrhea, nausea, vomiting.
• General disorders: fatigue, infusion-related reactions, peripheral edema.
• Metabolic and nutritional disorders: decreased appetite and weight loss.
• Musculoskeletal and Connective Tissue Disorders: arthralgia, musculoskeletal pain.
• Nervous system disorders: dizziness, headache.
• Respiratory, thoracic and mediastinal disorders: cough, dyspnea.
• Skin and subcutaneous tissue disorders: itching, rash.
• Vascular disease: hypertension.
• Laboratory index changes: anemia, hyperglycemia, increased aspartate aminotransferase (AST), increased alanine aminotransferase (ALT), increased lipase, increased amylase, increased bilirubin, lymphocytopenia, neutropenia, thrombocytopenia.

Serious adverse reactions:

• Blood disorders: anemia.
• Cardiovascular disease: hypertension.
• Gastrointestinal diseases: abdominal pain, intestinal obstruction.
• Infections: cellulitis, sepsis.
• Kidney disease: acute kidney injury, hematuria, urinary tract infection.
• Respiratory disorders: difficulty breathing.