Bavencio (avelumab) for Cancer Treatment: Interactions & Warnings

What is Bavencio, and how does it work?

Bavencio is a prescription medicine used to treat:

a type of skin cancer called Merkel cell carcinoma (MCC) in adults and children 12 years of age and older. Bavencio may be used when your skin cancer has spread.
a type of cancer in the bladder or urinary tract called urothelial carcinoma (UC). Bavencio may be used when your cancer:
- has spread or cannot be removed by surgery (advanced UC), and
- you have received chemotherapy that contains platinum, and it did not work or is no longer working.
a type of kidney cancer called renal cell carcinoma (RCC). Bavencio may be used with the medicine axitinib as your first treatment when your kidney cancer has spread or cannot be removed by surgery (advanced RCC).
It is not known if Bavencio is safe and effective in children under the age of 12.

What are the side effects of Bavencio?

Bavencio can cause serious side effects, including:

The most common side effects of Bavencio in people with MCC include:

feeling tired
muscle and bone pain
diarrhea
nausea
infusion-related reaction including chills, fever and back pain
rash
decreased appetite
swelling in your hands, feet, or ankles

The most common side effects of Bavencio in people with UC include:

feeling tired
infusion-related reaction including chills, fever, back pain, redness and shortness of breath
muscle and bone pain
nausea
decreased appetite
urinary tract infection

The most common side effects of Bavencio when given with axitinib in people with RCC include:

diarrhea
feeling tired
high blood pressure
muscle and bone pain
nausea
mouth sores
liver problems
blisters or rash on the palms of your hands and soles of your
feet
hoarseness
decreased appetite
low levels of thyroid hormone
rash
shortness of breath
cough
stomach-area (abdomen) pain
headache

These are not all the possible side effects of Bavencio. Ask your healthcare provider or pharmacist for more information.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What is the dosage for Bavencio?

Premedication

Premedicate patients with an antihistamine and with
acetaminophen prior to the first 4 infusions of Bavencio. Premedication should
be administered for subsequent Bavencio doses based upon clinical judgment and
presence/severity of prior infusion reactions.

Recommended Dosage For MCC

The recommended dose of Bavencio is 800 mg administered as an intravenous infusion over 60 minutes every 2 weeks until disease progression or unacceptable toxicity.

Recommended Dosage For UC

The recommended dose of Bavencio is 800 mg administered as an intravenous infusion over 60 minutes every 2 weeks until disease progression or unacceptable toxicity.

Recommended Dosage For RCC

The recommended dose of Bavencio is 800 mg administered as an intravenous infusion over 60 minutes every 2 weeks in combination with axitinib 5 mg orally taken twice daily (12 hours apart) with or without food until disease progression or unacceptable toxicity.
When axitinib is used in combination with Bavencio, dose escalation of axitinib above the initial 5 mg dose may be considered at intervals of two weeks or longer.
Review the Full Prescribing Information for axitinib prior to initiation.

Dose Modifications

Recommended dose modifications of Bavencio for adverse reactions are provided in Table 1.
Detailed information regarding clinical and laboratory monitoring guidelines for early detection of adverse reactions of
Bavencio and recommended management (immunosuppressant treatment guidelines) are described in
the prescription labeling.

Table 1: Recommended Dose Modifications of Bavencio for Adverse Reactions

Treatment-Related Adverse ReactionSeverity of Adverse ReactionsDose ModificationPneumonitisGrade 2 pneumonitisWithhold
Bavencio.
Resume Bavencio in patients with complete or partial resolution (Grade 0 to 1) of pneumonitis after corticosteroid taper.Grade 3 or 4 pneumonitis or recurrent Grade 2 pneumonitisPermanently discontinue.Hepatitis. For
Bavencio in combination with axitinib, see below.Aspartate aminotransferase (AST)/or alanine aminotransferase (ALT) more than 3 and up to 5 times the upper limit of normal or total bilirubin more than 1.5 and up to 3 times the upper limit of normalWithhold
Bavencio.
Resume Bavencio in patients with complete or partial resolution (Grade 0 to 1) of hepatitis after corticosteroid taper.AST or ALT more than 5 times the upper limit of normal or total bilirubin more than 3 times the upper limit of normalPermanently discontinue.
Colitis Grade 2 or 3 diarrhea or colitisWithhold Bavencio.
Resume
Bavencio in patients with complete or partial resolution (Grade 0 to 1) of colitis or diarrhea after corticosteroid taper.Grade 4 diarrhea or colitis or recurrent Grade 3 diarrhea or colitisPermanently discontinue.
Endocrinopathies (including but not limited to hypothyroidism,
hyperthyroidism, adrenal insufficiency, hyperglycemia) Grade 3 or 4Withhold
Bavencio.
Resume Bavencio in patients with complete or partial resolution (Grade 0 to 1) of endocrinopathies after corticosteroid taper.
Nephritis and Renal DysfunctionSerum creatinine more than 1.5 and up to 6 times the upper limit of normalWithhold
Bavencio.
Resume Bavencio in patients with complete or partial resolution (Grade 0 to 1) of nephritis and renal dysfunction after corticosteroid taper.Serum creatinine more than 6 times the upper limit of normalPermanently discontinue.Other immune-mediated adverse reactions (including but not limited to myocarditis, pancreatitis, myositis, psoriasis, arthritis, exfoliative dermatitis, erythema multiforme, pemphigoid, hypopituitarism, uveitis, Guillain-Barré syndrome, bullous dermatitis,For any of the following:

Moderate or severe clinical signs or symptoms of an immune-mediated adverse reaction not described above
Grade 3 or 4 endocrinopathies

Withhold
Bavencio pending clinical evaluation.
Resume Bavencio in patients with complete or partial resolution (Grade 0 to 1) of other immunemediated adverse reactions after corticosteroid taper.Stevens Johnson Syndrome (SJS)/toxic epidermal necrolysis (TEN),
rhabdomyolysis, myasthenia gravis, histiocytic necrotizing lymphadenitis,
demyelination, vasculitis, hemolytic anemia, hypophysitis, iritis, and
encephalitis)* For any of the following:

Life-threatening adverse reaction (excluding endocrinopathies)
Recurrent severe immune-mediated adverse reaction
Requirement for 10 mg per day or greater prednisone or equivalent for more than 12 weeks
Persistent Grade 2 or 3 immune-mediated adverse reactions lasting 12 weeks or longer

Permanently discontinue.Infusion-related reactionGrade 1 or 2Interrupt or slow the rate of infusion.Grade 3 or 4Permanently discontinue.* Observed with
Bavencio or with other anti-PD-1/PD-L1 monoclonal antibodies.

In patients with RCC being treated with
Bavencio in combination with axitinib:

If ALT or AST ≥ 3 times ULN but < 5 times ULN or total bilirubin ≥ 1.5 times ULN but < 3 times ULN, withhold both
Bavencio and axitinib until these adverse reactions recover to Grades 0-1. If persistent (greater than 5 days), consider corticosteroid therapy [initial dose of 0.5 to 1 mg/kg/day] prednisone or equivalent followed by a taper. Consider rechallenge with a single drug or sequential rechallenge with both drugs after recovery. Dose reduce per the axitinib Full Prescribing Information if rechallenging with axitinib.
If ALT or AST ≥ 5 times ULN or > 3 times ULN with concurrent total bilirubin ≥ 2 times ULN or total bilirubin ≥ 3 times ULN, permanently discontinue both
Bavencio and axitinib and consider corticosteroid therapy [initial dose 1 to 2 mg/kg/day prednisone or equivalent followed by a taper].

When
Bavencio is administered in combination with axitinib, review the axitinib Full Prescribing Information for recommended dose modifications for axitinib.

What drugs interact with Bavencio?

No Information Provided

Is Bavencio safe to use while pregnant or breastfeeding?

Based on its mechanism of action, Bavencio can cause fetal harm when administered to a pregnant woman.
There are no available data on the use of Bavencio in pregnant women.
There is no information regarding the presence of avelumab in human milk, the effects on the breastfed infant, or the effects on milk production.
Since many drugs including antibodies are excreted in human milk, advise a lactating woman not to breastfeed during treatment and for at least one month after the last dose of
Bavencio due to the potential for serious adverse reactions in breastfed infants.