Anti-PD-L1 Monoclonal Antibody — Immune Checkpoint Inhibitor (Specialist Oncology Drug)

Avelumab

Brand names: Bavencio

Adult dose

Dose: Refer to BNF, SmPC, and current SACT protocol

Route: Intravenous infusion

Frequency: Every 2 weeks as per SACT protocol

Clinical pearls

Indicated for: (1) Merkel cell carcinoma (MCC) — first-line and after chemotherapy; (2) urothelial carcinoma — maintenance therapy after platinum-containing chemotherapy (with axitinib combination in some settings)
NICE TA521 (2018): avelumab for MCC; NICE TA644 (2020): avelumab maintenance for urothelial carcinoma
Merkel cell carcinoma is rare and aggressive — avelumab first anti-PD-L1 approved for MCC
JAVELIN Bladder 100 trial: avelumab maintenance improved OS vs. best supportive care in urothelial carcinoma
irAE management identical to other anti-PD-L1 agents — see atezolizumab pearls
Premedication mandatory for first 4 infusions (antihistamine + paracetamol)

Contraindications

Active severe autoimmune disease (specialist assessment required)
See SmPC

Side effects

Infusion-related reactions (common — premedicate with antihistamine and paracetamol for first 4 infusions)
Immune-related adverse events (irAEs): pneumonitis, colitis, hepatitis, thyroid disorders, nephritis, myocarditis
Fatigue
Nausea

Interactions

Immunosuppressants — may reduce efficacy if used prophylactically

Monitoring

Tumour response per SACT protocol
TFTs monthly
LFTs, renal function
Symptoms of irAEs
Infusion reactions during administration
FBC

Reference: BNF; 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; https://bnf.nice.org.uk/drugs/avelumab/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Atezolizumab · Anti-PD-L1 Monoclonal Antibody — Immune Checkpoint Inhibitor (Specialist Oncology Drug)

Pathways