Avelumab (Bavenicio ®)
Classification: Monoclonal Antibody
About Avelumab (Bavenicio ®)
Avelumab is a programmed death ligand 1 (PDL-1) blocking antibody. It is an engineered monoclonal antibody that binds to certain proteins and activates the body’s immune response against the tumor, slowing tumor growth.
How to Take Avelumab
Avelumab is given through an intravenous (IV) infusion over 60 minutes, typically every two weeks until the disease has progressed or the severity of the side effects outweigh the benefit of receiving the medication. The dose is based on your weight and may be adjusted if you have reactions to the medication. Prior to the first four infusions, you will be given acetaminophen and an antihistamine (such as Benadryl) to prevent a reaction. After the fourth infusion, these are given if your team feels you are at risk for a reaction.
Possible Side Effects of Avelumab
There are a number of things you can do to manage the side effects of avelumab. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:
Allergic or infusion reactions may occur during the treatment. You will be given an antihistamine, such as diphenhydramine, and acetaminophen (Tylenol®) before your treatment to reduce the chance of a reaction.
During the infusion, if you experience fever, chills, flushing, low blood pressure, shortness of breath, wheezing, back or belly pain, hives or any other new side effect during the infusion inform your nurse immediately. Additional medications may be given to alleviate your symptoms. Your infusion may be slowed or temporarily stopped.
Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.
Your doctor or nurse can recommend medication and other strategies to relieve pain.
Diarrhea can be a sign of a very serious side effect of this medication. Report any change in stool to your oncology team.
With your team’s approval, you can try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration.
Nausea and/or Vomiting
Talk to your doctor or nurse so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms.
Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.
Decrease in Appetite
Nutrition is an important part of your care. Cancer treatment can affect your appetite and, in some cases, the side effects of treatment can make eating difficult. Ask your nurse about nutritional counseling services at your treatment center to help with food choices.
- Try to eat five or six small meals or snacks throughout the day, instead of 3 larger meals.
- If you are not eating enough, nutritional supplements may help.
- You may experience a metallic taste or find that food has no taste at all. You may dislike foods or beverages that you liked before receiving cancer treatment. These symptoms can last for several months or longer after treatment ends.
- Avoid any food that you think smells or tastes bad. If red meat is a problem, eat chicken, turkey, eggs, dairy products and fish without a strong smell. Sometimes cold food has less of an odor.
- Add extra flavor to meat or fish by marinating it in sweet juices, sweet and sour sauce or dressings. Use seasonings like basil, oregano or rosemary to add flavor. Bacon, ham and onion can add flavor to vegetables.
Some patients may develop a rash, scaly skin, or red itchy bumps. Use an alcohol free moisturizer on your skin and lips; avoid moisturizers with perfumes or scents. Your doctor or nurse can recommend a topical medication if itching is bothersome. If your skin does crack or bleed, be sure to keep the area clean to avoid infection. Be sure to notify your healthcare provider of any rash that develops, as this can be a reaction. They can give you more tips on caring for your skin.
This medication stimulates your immune system. Your immune system can attack normal organs and tissues in your body, leading to serious or life threatening complications. It is important to notify your healthcare provider right away if you develop any of the following symptoms:
- Lung problems (Pneumonitis): New or worsening cough, shortness of breath, trouble breathing, or chest pain.
- Liver problems (Hepatitis): Yellowing of the skin or eyes, your urine appears dark or brown, pain in your abdomen, bleeding or bruising more easily than normal, or severe nausea and vomiting.
- Intestinal problems (Colitis): Abdominal pain, diarrhea, cramping, mucus or blood in the stool, dark or tar-like stools, fever. Diarrhea means different things to different people. Any increase in your normal bowel patterns can be defined as diarrhea and should be reported to your healthcare team.
- Kidney problems: decreased urine output, blood in the urine, swelling in the ankles, loss of appetite.
- Eye problems: blurry or double vision, and changes in vision, eye pain or redness.
- Skin reactions: report rash, with or without itching (pruritis), sores in your mouth, blistering or peeling skin, as these can become severe and require treatment with corticosteroids.
Patients can experience immune-mediated reactions that affect the thyroid, pancreas and adrenal glands. These reactions can cause inflammation of these glands and affect their production of certain hormones. Some hormone levels will be monitored with blood work. It is important that you report any changes in how you are feeling to your care team.
Symptoms of these hormonal changes can include: rapid heart rate, increased sweating, extreme tiredness, feeling more hungry or thirsty, hair loss, changes in mood, feeling cold, constipation, deeper voice, lower blood pressure, urinating more frequently, dizziness, fainting, nausea, vomiting, and abdominal pain.
Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment and for at least one month after last treatment. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should consult with your healthcare team before breastfeeding while receiving this medication.