Avelumab is administered intravenously (IV), and it is typically given in a hospital or clinical setting under the supervision of a healthcare professional. The standard dose of avelumab is 10 mg/kg administered as an IV infusion once every two weeks.
The infusion period is 60 minutes, although the time may vary with the patient’s ability to tolerate the infusion and the facility’s protocols.
Before getting the drug, patients should be assessed for history or ongoing autoimmune diseases or conditions that can predispose the patient to increased side effects, since this drug triggers immune-related adverse reactions.
The patient should continue with treatment when they start feeling better because withdrawal from the medication before completing the prescription course will undermine the effectiveness of the medication.
Avelumab acts as an immune checkpoint inhibitor. It specifically targets and suppresses PD-L1, which is a ligand expressed on tumor cells and some types of immune cells, that it interacts with the PD-1 receptor of T-cells. The typical interaction of PD-1 and PD-L1 dampens the immune response by inhibiting T-cell activation and thus promoting immune tolerance, allowing the tumors to evade an immune response and attack.
Avelumab works by binding to PD-L1, blocking it from binding to the PD-1 receptor on T-cells, a process known as turning “off the brakes.” In such a way, T-cells become activated and provide more robust anti-tumor immune responses. This is crucial in cancers like Merkel cell carcinoma and urothelial carcinoma, in which tumor cells evaded immune detection mainly through the PD-1/PD-L1 pathway.
As is true with most immunotherapy drugs, avelumab can cause many different side effects. The common ones include:
- Fatigue
- Nausea
- Diarrhea
- Rash or Skin Reactions: Avelumab can be associated with rashes, pruritus, or other cutaneous reaction.
- Loss of appetite
- Infusion-related reactions: Fever, chills, and shortness of breath can occur at or shortly following infusion.
- Other serious side effects include:
- Lung complications: Pneumonitis can cause dyspnea (difficulty breathing) and cough.
- Colitis (inflammation of the colon) can be causing severe abdominal pain or diarrhea.
Immune-mediated Side Effects: Avelumab can cause serious immune-related side effects, including inflammation in organs such as the lungs, liver, kidneys, and gastrointestinal system. It is essential to monitor for symptoms of organ inflammation and address them immediately.
Pneumonitis: Patients should be monitored for signs of pneumonitis, which can cause symptoms such as cough, shortness of breath, or chest pain.
Endocrinologic: Thyroid function should be monitored periodically because of the incidence of thyroiditis, which could lead to hypothyroidism or hyperthyroidism.
Colitis: Both severe diarrhea and colitis can occur; therefore, patients should report abdominal pain, severe diarrhea, or blood in stool.
Liver dysfunction: Monitor liver function carefully during treatment with avelumab, and assess the patient for signs of hepatitis or liver failure.
Anturol may interact with other drugs, leading to increased side effects or reduced effectiveness. Always inform your doctor of any medications you are taking.
Avelumab dosing should be through intravenous administration at a dose of approximately 10 mg/kg twice every week. The infusion duration should be at about 60 minutes.
Infusions might be extended based on a person’s response or clinical status. In case of any adverse effect or reaction within the infusion, the healthcare provider can modify the infusion time or administer medications to treat them.
The duration of avelumab treatment is determined by the response to therapy and by side effects. In patients who develop severe immune-related adverse effects, treatment is stopped, and immunosuppressive drugs are used to manage the adverse reactions.
Avelumab is a prescription drug. It should be prescribed by a healthcare provider, which is usually an oncologist, after a proper assessment of the type of cancer, the patient’s health conditions, and previous treatments done on the patient. Before starting the treatment, the patient will undergo evaluation for any already existing conditions especially autoimmune diseases, due to higher risk of severe immune-related adverse effects.
Patients should not use avelumab if they have any pregnancies or are breast-feeding, and should inform their healthcare provider of any other drugs for which they are currently prescribed, especially other immunosuppressants or cancer drugs.