Bavencio
Bavencio (avelumab) is an immunotherapy medication that’s used for several types of cancers like bladder cancer and kidney cancer. It can also be used for a certain type of skin cancer called Merkel cell carcinoma. Bavencio (avelumab) is most often used by itself, but it can also be used with other anticancer medications in some situations. Some of the more common side effects of Bavencio (avelumab) include tiredness, muscle pain, and joint pain. This medication can also cause serious side effects, like infusion reactions and severe diarrhea.
What is Bavencio (avelumab)?
What is Bavencio (avelumab) used for?
Metastatic Merkel cell carcinoma in people aged 12 years and older
Locally advanced or metastatic bladder cancer that’s currently or previously treated with platinum-containing chemotherapy
Advanced kidney cancer, given with Inlyta (axitinib)
How Bavencio (avelumab) works
Bavencio (avelumab) is a type of immunotherapy called a PD-L1 inhibitor. It works against a specific protein on cancer cells called programmed cell death ligand 1 (PD-L1). Cancer cells that have PD-L1 can hide from the body’s immune system. This means that the immune system can’t detect, attack, and kill these cancer cells. As a result, the cancer is able to grow.
When Bavencio (avelumab) attaches to PD-L1 on cancer cells, the cancer cells can’t hide from the immune system anymore. This helps the immune system find and kill cancer cells better. This type of immunotherapy is also known as an immune checkpoint inhibitor.
Drug Facts
What are the side effects of Bavencio (avelumab)?
Common Side Effects
- Diarrhea (up to 62%)
- Fatigue (up to 53%)
- High blood pressure (up to 50%)
- Higher liver enzymes in the blood (up to 50%)
- Muscle and bone pain (up to 40%)
- Nausea (up to 34%)
- Lower appetite (up to 26%)
- Rash (up to 25%)
- Low thyroid hormone levels (hypothyroidism, up to 25%)
- Cough (up to 23%)
- Shortness of breath (up to 23%)
- Infusion-related reaction (up to 22%)
- Stomach pain (up to 22%)
- Headache (up to 21%)
Other Side Effects
- Swelling in arms, legs, or feet
- Hand-foot syndrome
- Mouth sores
- Hoarse voice
- Urinary tract infection
Serious Side Effects
- Immune-related side effects: cough, shortness of breath, chest pain, rash, diarrhea, stomach pain, mucus or blood in stool
- Serious infusion reactions: trouble breathing, itching, hives, flushing, swelling, chest pain, fast heartbeat, dizziness, fainting
- Heart problems: shortness of breath; swelling in hands, feet, and ankles; new chest pain; feeling dizzy or lightheaded; pain in your arms, neck, or back
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Dry cough, shortness of breath or trouble breathing
- Eye pain, redness, irritation, or discharge with blurry or decreased vision
- Heart attack—pain or tightness in the chest, shoulders, arms, or jaw, nausea, shortness of breath, cold or clammy skin, feeling faint or lightheaded
- Heart muscle inflammation—unusual weakness or fatigue, shortness of breath, chest pain, fast or irregular heartbeat, dizziness, swelling of the ankles, feet, or hands
- Hormone gland problems—headache, sensitivity to light, unusual weakness or fatigue, dizziness, fast or irregular heartbeat, increased sensitivity to cold or heat, excessive sweating, constipation, hair loss, increased thirst or amount of urine, tremors or shaking, irritability
- Infusion reactions—chest pain, shortness of breath or trouble breathing, feeling faint or lightheaded
- Kidney injury (glomerulonephritis)—decrease in the amount of urine, red or dark brown urine, foamy or bubbly urine, swelling of the ankles, hands, or feet
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Pain, tingling, or numbness in the hands or feet, muscle weakness, change in vision, confusion or trouble speaking, loss of balance or coordination, trouble walking, seizures
- Rash, fever, and swollen lymph nodes
- Redness, blistering, peeling, or loosening of the skin, including inside the mouth
- Sudden or severe stomach pain, bloody diarrhea, fever, nausea, vomiting
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Bone, joint, or muscle pain
- Diarrhea
- Fatigue
- Loss of appetite
- Nausea
- Skin rash
Pros and cons of Bavencio (avelumab)
Pros
Short infusion time (only 1 hour)
Given once every 2 weeks
Can take with other anticancer medications to treat kidney cancer
Cons
Requires regular visits to a hospital or infusion center for treatments
Can cause immune-related side effects that can affect any organ (though most commonly rash and diarrhea)
Not safe during pregnancy since it can harm an unborn baby
Pharmacist tips for Bavencio (avelumab)
Each infusion appointment can take a couple hours. The appointment includes the time it takes for you to check in, get any medications before your infusion (“pre-medications”), and get the infusion of Bavencio (avelumab). It’ll also take time for your healthcare provider to watch you for any side effects during and after your infusion.
Although rare, you might experience a serious reaction during or shortly after your Bavencio (avelumab) infusion. To help lower your risk of an infusion reaction, you’ll receive pre-medications before each of your first 4 infusions and then as needed. These pre-medications include acetaminophen (Tylenol) and an antihistamine, like diphenhydramine (Benadryl). Let your provider know or get help right away if you experience any symptoms of an infusion reaction, like trouble breathing, hives, flushing, chest pain, fast heartbeat, or dizziness.
Make sure you have what you need to be comfortable for your Bavencio (avelumab) infusions. Wear sleeves that are easy to roll up, bring a water bottle to help you stay hydrated, and bring a snack.
Stay on track with your Bavencio (avelumab) infusions. You can set calendar reminders or use an app that can help remind you to get your infusions on time. If you miss an infusion appointment, contact your healthcare provider to discuss how to get back on track.
Diarrhea is a common side effect of Bavencio (avelumab). If you have diarrhea during treatment, let your healthcare provider know. For mild diarrhea, your provider might recommend over-the-counter medications like loperamide (Imodium A-D). You can also avoid foods that are greasy, fatty, or spicy and eat small, frequent meals to help. But if it’s more severe, you might need to take corticosteroid medications or even take a break from Bavencio (avelumab) treatment. Be sure to stay hydrated by drinking plenty of clear, noncarbonated drinks.
Make sure to get any blood work done on time as your healthcare provider instructed you to during treatment with Bavencio (avelumab). These blood tests are important for your provider to check for other side effects that might not be noticeable (e.g., kidney, liver, and thyroid health).
If you’re able to become pregnant, you should use birth control while receiving Bavencio (avelumab) and for at least 1 month after the last dose. This medication can cause harm to an unborn baby. Let your provider know right away if you become pregnant during treatment.
Frequently asked questions about Bavencio (avelumab)
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What are the risks and warnings for Bavencio (avelumab)?
Bavencio (avelumab) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Immune-related side effects
Risk factors: Previous radiation to the chest area | Taking Inlyta (axitinib) at the same time
Bavencio (avelumab) works by ramping up your immune system. But as a result, an overactive immune system can attack any area of your body, which can affect how your organs normally work. Some examples of immune-related side effects include rash, lung problems (trouble breathing), diarrhea, and liver problems, among many others. These side effects can become severe or life-threatening. Immune-related side effects most commonly occur during treatment, but can also still happen even after you’ve stopped treatment with Bavencio (avelumab).
Your healthcare provider will check for the development of immune-related side effects. They’ll monitor your liver, kidney, and thyroid functions through various lab tests during treatment. They’ll also follow up with you on any symptoms you might have. If you experience immune-related side effects, your healthcare provider will examine you to see how severe your symptoms are. Then, they might recommend that you take other medications, like corticosteroids, or stop taking Bavencio (avelumab) altogether.
Infusion reactions
Bavencio (avelumab) can cause infusion reactions, most commonly fever and chills. In clinical trials with Bavencio (avelumab), about 25% of people experienced an infusion reaction. These reactions are usually mild and tolerable, but in rare cases, they can be serious. They can also happen during or several hours after the infusions. Alert your provider or get medical help right away if you experience any throat tightness, wheezing, trouble breathing, fever, chills, hives, flushing, dizziness, or back or stomach pain.
Serious heart problems when taken together with Inlyta (axitinib) for advanced kidney cancer
Taking Bavencio (avelumab) together with Inlyta (axitinib) can raise your risk for severe and life-threatening heart problems. In studies, these problems have included heart attack and heart failure. Because of this risk, your healthcare provider might check your heart function periodically during treatment. Managing any high blood pressure, high cholesterol, or diabetes that you might have can also help lower your risk of heart problems. If you develop serious heart problems, your healthcare provider might recommend stopping treatment with Bavencio (avelumab). Let your healthcare provider know right away if you experience any new or worsening chest pain, shortness of breath, or swelling in the hands, feet, or ankles.
Complications of stem cell transplant
Taking an immunotherapy medication like Bavencio (avelumab) before or after receiving certain types of stem cell transplants can cause serious and fatal problems. One example of a transplant-related complication is graft-versus-host-disease (GVHD). Let your healthcare provider know if you’ve received a stem cell transplant before taking Bavencio (avelumab). Also notify your provider if you’re planning to have a stem cell transplant after treatment with Bavencio (avelumab).
Harm to unborn baby
Bavencio (avelumab) can harm an unborn baby when taken during pregnancy. Because of this risk, if you can get pregnant, you should use birth control while receiving Bavencio (avelumab) and for at least 1 month after the last dose. Let your provider know right away if you become pregnant during this time.
Bavencio (avelumab) dosage forms
Typical dosing for Bavencio (avelumab)
The typical dose is 800 mg as an infusion through the vein (intravenous or IV) once every 2 weeks.
What are alternatives to Bavencio (avelumab)?
Metastatic Merkel cell carcinoma in people aged 12 years and older
Locally advanced or metastatic bladder cancer that’s currently or previously treated with platinum-containing chemotherapy
Advanced kidney cancer, given with Inlyta (axitinib)
Non-small cell lung cancer (NSCLC)
Renal cell carcinoma (kidney cancer)
Endometrial carcinoma (uterine cancer)
Squamous cell carcinoma (a type of skin cancer)
Cancers with high tumor mutation burden (TMB-H), high microsatellite instability (MSI-H), or deficient mismatch repair (dMMR)
Non-small cell lung cancer (NSCLC)
Pleural mesothelioma (cancer of the lining of the lungs)
Renal cell carcinoma (kidney cancer)
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References
Best studies we foundAmerican Cancer Society. (2018). What is Merkel cell carcinoma?
American Cancer Society. (2020). What are infusion or immune reactions?
American Cancer Society. (2020). What is kidney cancer?
American Cancer Society. (2022). What is bladder cancer?
Cancer.net. (2022). Side effects of immunotherapy.
EMD Serono, Inc. (2022). Bavencio- avelumab injection, solution, concentrate [package insert]. DailyMed.
Han, Y., et al. (2020). PD-1/PD-L1 pathway: Current researches in cancer. American Journal of Cancer Research.
Leukemia & Lymphoma Society. (n.d.). Allogeneic stem cell transplantation.
Leukemia & Lymphoma Society. (n.d.). Graft-versus-host disease.
National Cancer Institute. (n.d.). PD-L1.
National Cancer Institute. (2022). Immune checkpoint inhibitors.
National Comprehensive Cancer Network. (2022). Immunotherapy side effects: Immune checkpoint inhibitors.
National Comprehensive Cancer Network. (2022). Understanding immunotherapy side effects.
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