Avelumab
Brand names: Bavencio
Avelumab is a monoclonal antibody immune checkpoint inhibitor used in certain cancers, including Merkel cell carcinoma and urothelial carcinoma.
Adult dose
Dose independently re-sourced from US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.
Contraindications
- None stated — the US label §4 CONTRAINDICATIONS reads 'None.'
Side effects
- Immune-mediated adverse reactions, which may be severe or fatal, in any organ system — including pneumonitis, colitis, hepatitis, endocrinopathies, nephritis with renal dysfunction and dermatologic reactions; may result in solid organ transplant rejection
- Infusion-related reactions
- MCC (at least 20%): fatigue, musculoskeletal pain, infusion-related reaction, rash, nausea, constipation, cough and diarrhoea
- UC maintenance (at least 20%): fatigue, musculoskeletal pain, urinary tract infection and rash
- RCC with axitinib (at least 20%): diarrhoea, fatigue, hypertension, musculoskeletal pain, nausea, mucositis, palmar-plantar erythrodysaesthesia, dysphonia, decreased appetite, hypothyroidism, rash, hepatotoxicity, cough, dyspnoea, abdominal pain and headache
- Major adverse cardiovascular events (discontinue avelumab in combination with axitinib for Grade 3–4 events) and complications of allogeneic HSCT
Clinical monograph
How it works
It binds programmed death-ligand 1 (PD-L1), blocking its interaction with PD-1 and restoring T-cell-mediated anti-tumour immune responses.
Prescribing in practice
- It can cause immune-related adverse effects affecting many organ systems, which may be serious and require corticosteroids and treatment interruption.
- Infusion-related reactions can occur and premedication may be used to reduce risk.
- It is a specialist oncology medicine administered by intravenous infusion under cancer services.
Monitoring
Monitor for immune-related adverse effects across organ systems and for infusion reactions before and during each cycle.
Counselling the patient
- Report any new or worsening symptoms such as diarrhoea, breathlessness, rash or fatigue, as these may reflect immune-related effects.
- Carry an alert card identifying you as receiving immunotherapy.
Evidence & guidelines
Avelumab is supported by clinical trial evidence in Merkel cell and urothelial carcinoma and is recommended within defined indications.
Reference: NICE TA521 (Avelumab for Merkel cell carcinoma, 2018); NICE TA644 (Avelumab maintenance for urothelial carcinoma, 2020); JAVELIN Bladder 100 trial (NEJM 2020); ESMO MCC Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).
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