Avelumab (also known as Bavencio) is a type of immunotherapy. You might have it as a treatment for
- merkel cell carcinoma (MCC) that has spread to other parts of the body
- a type of kidney cancer called renal cell cancer that has spread
How avelumab works
Avelumab is a type of immunotherapy called a checkpoint inhibitor. This type of treatment stimulates the body’s immune system to fight cancer cells.
Avelumab targets and blocks a protein called PD-L1 on the surface of certain immune cells. Blocking PD-L1 activates the immune cells to find and kill cancer cells.
How you have avelumab
You have avelumab as a drip into your bloodstream (intravenously). It takes about an hour each time you have it.
Into your bloodstream
You can have the drug through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.
Or you might have it through a long line: a central line, a PICC line or a portacath.
These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment.
When you have avelumab
You have avelumab every 2 weeks. You have it for as long as it helps you and the side effects aren’t too bad.
You might have paracetamol and an anti histamine drug before at least the first 4 avelumab treatments. This reduces your risk of having an allergic reaction during treatment.
You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver, thyroid and kidneys are working.
How often and how severe the side effects are can vary from person to person. They also depend on what other treatment you are having.
When to contact your team
Your doctor, pharmacist or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
- you have severe side effects
- your side effects aren’t getting any better
- your side effects are getting worse
Early treatment can help manage side effects better.
We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.
Common side effects
These effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:
A reaction during the infusion
A reaction may happen during the infusion. Symptoms can include a skin rash, itching, swelling of the lips, face or throat, breathing difficulties, fever and chills. Your nurse will give you medicines beforehand to try to prevent a reaction.
Diarrhoea and inflamed bowel
Tell your doctor or nurse if you have diarrhoea. Your doctor might give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty of liquid to replace the fluid lost.
Tiredness and weakness (fatigue) can happen during and after treatment. Doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.
Let your doctor know if you are more tired than usual.
Loss of appetite and weight loss
You might not feel like eating and may lose weight. It is important to eat as much as you can. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss.
Difficulty breathing and cough
You may have difficulty breathing or a cough. Let your doctor or nurse know straight away if you have these symptoms. They can give you medicine to help.
Breathlessness and looking pale
You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.
Feeling or being sick
Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.
It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.
Tummy (abdominal) pain
Tell your treatment team if you have this. They can check the cause and give you medicine to help.
Pain in your back or joints
Let your doctor know if you have pain in your back or joints. There are lots of ways to treat pain, including painkillers and relaxation.
Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your doctor, nurse or pharmacist if you are constipated for more than 3 days. They can prescribe a laxative.
If you get a high temperature, let your healthcare team know straight away. Ask them if you can take paracetamol to help lower your temperature.
Swollen hands and feet
Swelling of hands and feet is due to fluid build up. This is called oedema. Let your doctor or nurse know if you have any swelling.
Occasional side effects
These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:
- low levels of white blood cells in your body which can increase your risk of getting an infection
- headaches and dizziness - tell your doctor or nurse if you have these symptoms
- numbness and tingling in fingers and toes which can make it difficult doing up buttons
- low levels of thyroid hormones that can make you feel tired and cold
- high or low blood pressure
- inflammation of the lung tissue (pneumonitis)
- dry mouth
- skin changes such as a rash, itching and dry skin
- pain in your muscles
- flu like symptoms such as shivering, chills and feeling generally unwell
- higher levels of liver and pancreatic enzymes that are usually temporary and go back to normal once you stop treatment
Rare side effects
These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:
- a drop in the levels of platelets in your body which can increase your risk of bruising, bleeding and nosebleeds
- high blood sugar levels (diabetes)
- inflammation in different parts of your body such as the heart, thyroid, eyes, bowel, liver and kidneys
- problems with your nerves that can cause numbness, weakness and pain
- low levels of different hormones in your body
Coping with side effects
We have more information about side effects and tips on how to cope with them.
What else do I need to know?
Other medicines, foods and drinks
Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.
Loss of fertility
It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
Contraception and pregnancy
This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for at least a month afterwards.
Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner falls pregnant while having treatment.
It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.
Treatment for other conditions
Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.
Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.
In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.
You can have:
- other vaccines, but they might not give you as much protection as usual
- the flu vaccine (as an injection)
- the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment
Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your
Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.
If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.
Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.
More information about this treatment
For further information about this treatment go to the electronic Medicines Compendium (eMC) website.
You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.
This page is due for review. We will update this as soon as possible.