Avelumab — Drug Monograph
Brand names: Bavencio
Drug class: Checkpoint Inhibitor
Mechanism of Action
Human IgG1 anti-PD-L1 monoclonal antibody. Blocks PD-L1/PD-1 and PD-L1/CD80 (B7-1) interactions. Uniquely among approved PD-L1 inhibitors, avelumab retains an intact IgG1 Fc region (unlike atezolizumab and durvalumab, which have engineered Fc regions to abolish ADCC). This allows avelumab to mediate natural killer (NK) cell-mediated ADCC against PD-L1-expressing tumor cells — providing a potential additional mechanism of tumor killing beyond checkpoint blockade alone.
FDA Indications
- Merkel cell carcinoma (MCC) — metastatic (first-line and previously treated)
- Urothelial carcinoma — locally advanced or metastatic, maintenance therapy for patients who have not progressed on first-line platinum-containing chemotherapy (JAVELIN Bladder 100 trial)
Common Side Effects
- Infusion-related reactions (25%; most common during first infusion)
- Fatigue
- Diarrhea
- Nausea
- Hypothyroidism
- Peripheral edema
- Urinary tract infections (maintenance UC setting)
Clinical Pearl
Avelumab was the first FDA-approved immunotherapy for Merkel cell carcinoma (MCC) — a rare but aggressive neuroendocrine skin cancer — and remains the only approved agent specifically in the maintenance urothelial carcinoma setting (JAVELIN Bladder 100, OS benefit regardless of PD-L1 status). MCC is highly immunogenic (driven by Merkel cell polyomavirus in ~80% of cases, or UV-mutational burden in virus-negative cases), which explains exceptional checkpoint inhibitor responses (~33% ORR with…
Related Therapies & Mechanisms
- Durvalumab (Imfinzi) — Checkpoint Inhibitor · Bladder
- Nivolumab (Opdivo) — Checkpoint Inhibitor · Bladder
- Pembrolizumab (Keytruda) — Checkpoint Inhibitor · Bladder
- Atezolizumab (Tecentriq) — Checkpoint Inhibitor