Classification: Monoclonal Antibody
About: Avelumab (Bavencio®)
Monoclonal antibodies are created in a lab to attach to the targets found on specific types of cancer cells. The antibody “calls” the immune system to attack the cell it is attached to, resulting in the immune system killing the cell. These antibodies can work in different ways, including stimulating the immune system to kill the cell, blocking cell growth or other functions necessary for cell growth.
Avelumab is a type of monoclonal antibody therapy, which works to stimulate the immune system to destroy cancer cells. T-cells are a type of white blood cell that are very important to the normal functioning of the immune system. Avelumab works as a form of immunotherapy and blocks the activity of programmed death ligand 1 (PDL-1), a molecule found on T cells that suppresses immune activity. By blocking PDL-1, T-cells function better and the immune response is stimulated to find and kill cancer cells.
How to Take Avelumab
Avelumab is given intravenously (directly into a vein). 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 only continued if your team feels you are at risk for a reaction. Your provider will determine how many doses you will receive and how often they will be given.
Make sure your care team is aware of all medications (including prescription and over-the-counter), supplements, and vitamins you are taking. Steroids should be avoided while on immunotherapy, unless directed by your care team.
Tell your care team about all your medical conditions, including those that autoimmune in nature (Crohn’s disease, lupus, rheumatoid arthritis, etc.) as these can get worse with immunotherapy. You should also notify your provider if you have had or plan on having an allogenic stem cell transplant as this medication can worsen a side effect of the transplant called graft-versus-host disease.
Possible Side Effects of Avelumab
There are a number of things you can do to manage the side effects of avelumab. Talk to your care team about these recommendations. They can help you decided what will work best for you. These are some of the most common or important side effects:
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, inflammation of the lung): New or worsening cough, shortness of breath, trouble breathing, or chest pain.
- Liver problems (hepatitis, inflammation of the liver): 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.
- Diarrhea / Intestinal problems (colitis, inflammation of the bowel): 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.
- Hormone abnormalities: Immune reactions can affect the pituitary, thyroid, pancreas and adrenal glands, resulting in inflammation of these glands, which can affect their production of certain hormones. Some hormone levels can 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: headaches, nausea, vomiting, constipation, rapid heart rate, increased sweating, extreme fatigue, weakness, changes in your voice, changes in memory and concentration, increased hunger or thirst, increased urination, weight gain, hair loss, dizziness, feeling cold all the time, and changes in mood or behavior (including irritability, forgetfulness and decreased sex drive).
- Kidney problems (kidney inflammation or failure): Decreased urine output, blood in the urine, swelling in the ankles, loss of appetite.
- 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.
- Brain and/or nerve problems: Report any headache, drooping of eyelids, double vision, trouble swallowing, weakness of arms, legs or face, or numbness or tingling in the hands or feet to your healthcare team.
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.
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.
Peripheral edema is swelling of the extremities caused by retention of fluid. It can cause swelling of the hands, arms, legs, ankles and feet. The swelling can become uncomfortable. Notify your provider if you are experiencing any new or worsening swelling.
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.
Less common, but important side effects can include:
- Cardiac Events: When this medication is given with another drug called axitinib, it can cause heart issues, although this is rare it is important to notify your provider right away of any changes in how your heart is working. If you have chest pain, shortness of breath, new or worsening edema or if your heartbeat feels irregular, you should contact your provider right away.
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 your 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 not breastfeed while taking this medication or for one month after your last dose.