Avelumab

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Information about Avelumab

avelumab (a-VEL-yoo-mab) is a drug used to treat urothelial carcinoma (a type of bladder cancer) that has advanced or spread to other parts of the body. It is used in patients whose disease got worse during or after treatment with anticancer drugs that included platinum. Avelumab is also used to treat Merkel cell cancer (a rare type of skin cancer) that has spread to other parts of the body. It is also being studied in the treatment of other types of cancer. Avelumab binds to a protein called PD-L1, which is found on some cancer cells. Avelumab may block PD-L1 and help the immune system kill cancer cells. It is a type of monoclonal antibody and a type of immune checkpoint inhibitor. Also called Bavencio.

Liver safety of Avelumab

Avelumab is a human monoclonal antibody to programmed cell death receptor ligand 1 (PD-L1), which modulates T cell immune reactivity and is used in the immunotherapy of cancer.  Avelumab has major side effects and particularly immune related conditions, including acute liver injury which can be serious and even life threatening. 

Mechanism of action of Avelumab

Avelumab (av el' ue mab) is a human recombinant monoclonal IgG1 antibody to the programmed cell death receptor ligand-1 (PD-L1) which has distinctive immunomodulatory activity and is used in cancer immunotherapy.  PD-1 is an important checkpoint molecule that modulates and down regulates T cell responses.  Antibody binding to the ligand prevents its binding to the programmed cell death receptor which thereby allows for a continued activation and proliferation of T cells.  The subsequent enhancement of cytotoxic reactivity may play a beneficial role in cancer immunotherapy by breaking immunological tolerance to cancer cell neo-antigens.  In several multicenter studies, avelumab therapy resulted in objective responses in patients with advanced, metastatic or unresectable malignant neoplasms, and a proportion of patients had a long term remission. 

FDA approval information for Avelumab

Avelumab was approved for use in metastatic Merkel cell carcinoma and advanced, refractory urothelial bladder carcinoma in the United States in 2017, and is currently under evaluation in several other forms of cancer, including NSCLC.  Avelumab is available in single use 10 mL vials of 200 mg (20 mg/mL) under the brand name Bavencio. 

Dosage and administration for Avelumab

The recommended dose is 2 mg/kg as an intravenous infusion every 2 weeks.  Premedication with acetaminophen and antihistamines is recommended for the first 4 infusions.  side effects are common and include fatigue, nausea, musculoskeletal pain, rash and infusion reactions. 

Side effects of Avelumab

Between 5% and 20% of treated patients develop immune related side effects as a result of immune enhancement including enterocolitis, dermatitis, endocrinopathy, pneumonitis, neuropathy, nephritis and hepatitis.  Most of these reactions respond to dose interruption and/or immunosuppressive therapy, but some have resulted in fatalities and some have required long term therapy.  Early recognition and prompt management of these side effects is an integral component of proper use of checkpoint inhibitors such as avelumab.

 


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