avelumab

High Alert

Metastatic Merkel cell carcinoma.
Maintenance treatment of patients with locally advanced or metastatic urothelial carcinoma that has not progressed with first-line platinum-containing chemotherapy.
Locally advanced or metastatic urothelial carcinoma in patients who have disease progression during or following platinum-containing chemotherapy or have disease progression within 12 mo of neoadjuvant or adjuvant treatment with platinum-containing chemotherapy.
Advanced renal cell carcinoma as first-line therapy (in combination with axitinib).

Contraind./Precautions ⬆ ⬇

Contraindicated in:

OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Diabetes, hypertension, and/or dyslipidemia;
Rep: Women of reproductive potential;
Pedi: Children <12 yr (safety and effectiveness not established).

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypertension, peripheral edema, HF, MI, MYOCARDITIS, pericarditis, vasculitis

Derm: pruritus, rash, DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS), STEVENS-JOHNSON SYNDROME (SJS), TOXIC EPIDERMAL NECROLYSIS (TEN)

EENT: iritis, uveitis

Endo: hypothyroidism, ADRENAL INSUFFICIENCY, hyperthyroidism, hypoparathyroidism, hypophysitis, type 1 diabetes

F and E: hyponatremia, hyperkalemia

GI: ↑lipase, ↑liver enzymes, abdominal pain, constipation, diarrhea, nausea, vomiting, ↑amylase, COLITIS, gastritis, HEPATITIS, pancreatitis

GU: urinary tract infection, nephritis

Hemat: anemia, lymphopenia, thrombocytopenia, hemolytic anemia, neutropenia

Metab: ↓appetite, weight loss

MS: pain, myositis, RHABDOMYOLYSIS

Neuro: dizziness, headache, autoimmune neuropathy, ENCEPHALITIS, Guillain-Barré syndrome, MENINGITIS, myasthenic syndrome, myelitis

Resp: cough, dyspnea, PNEUMONITIS

Misc: fatigue, fever, infusion-related reactions

Interactions ⬆ ⬇

Drug-drug:

None reported.

Availability ⬆ ⬇

Solution for injection: 20 mg/mL

Route/Dosage ⬆ ⬇

Merkel Cell Carcinoma

IV (Adults and Children ≥12 yr): 800 mg every 2 wk until disease progression or unacceptable toxicity.

Urothelial Carcinoma and Renal Cell Carcinoma

IV (Adults ): 800 mg every 2 wk until disease progression or unacceptable toxicity.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Binds to programmed death ligand 1 to prevent its interaction with the programmed cell death-1 and B7.1 (or CD80) receptors, which activates the antitumor immune response.

Therapeutic effects:

Decreased spread of Merkel cell carcinoma.
Decreased spread of and improved survival in urothelial carcinoma.
Improved progression-free survival in renal cell carcinoma.

Classifications ⬆ ⬇

Therapeutic Classification: antineoplastics

Pharmacologic Classification: monoclonal antibodies, programmed death ligand 1 pd l1 inhibitors

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Minimally distributed to tissues.

Metabolism/Excretion: Primarily eliminated via proteolytic degradation.

Half-Life: 6.1 days

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
IV	unknown	unknown	unknown

Patient/Family Teaching ⬆ ⬇

Explain purpose of avelumab to patient and family and inform of potential adverse reactions.
Instruct patient to notify health care professional immediately is signs and symptoms of infusion reactions occur.
Advise patient to notify health are professional immediately if signs and symptoms of pneumonitis; hepatitis (jaundice, severe nausea or vomiting, pain on right side of abdomen, lethargy, or easy bruising or bleeding); colitis; adrenal insufficiency (hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness); hypothyroidism (intolerance to cold, constipation, dry skin, headache, listlessness, tiredness, or weakness); hyperthyroidism (headache, nervousness, diarrhea, excessive sweating, heat intolerance, chest pain, increased pulse rate, palpitations, weight loss >2 lb/wk); diabetes mellitus (confusion; drowsiness; flushed, dry skin; fruit-like breath odor; rapid, deep breathing; polyuria; loss of appetite; unusual thirst); nephritis (decreased urine output, blood in urine, swelling in ankles, loss of appetite), skin reactions (rash, itching, rash with tiny spots or bumps, reddening of skin, blisters, peeling); or cardiovascular events (new or worsening chest discomfort, pain or pressure; swelling in feet or ankles; shortness of breath; nausea or vomiting; weight gain; pain or discomfort in arms, back, neck, or jaw, cold sweat; light-headedness or dizziness) occur.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other Rx, OTC, herbal products.
Rep: May cause fetal harm. Advise females of reproductive potential to use effective contraception and avoid breastfeeding during and for at least 1 mo after last dose of avelumab.

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Indications ⬇