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Avelumab is a PD-L1 blocker given as maintenance after chemotherapy for advanced bladder cancer, which lengthened survival by about seven months.
Avelumab is a fully human IgG1 antibody against PD-L1 with an intact Fc region, so it can trigger antibody-dependent cellular cytotoxicity as well as releasing the checkpoint brake. Its main role is maintenance after first-line platinum in advanced urothelial cancer: JAVELIN Bladder 100 showed OS 21.4 versus 14.3 months (HR 0.69), which made avelumab maintenance the standard after platinum in 2020. It is also approved in Merkel cell carcinoma and, with axitinib, in renal cell carcinoma. The maintenance role has been largely displaced in first-line urothelial cancer by EV plus pembrolizumab, but remains relevant where that combination is unavailable or contraindicated. Grade 3 or higher immune-related events occurred in 7%; Merck KGaA and Pfizer developed it. Starting immunotherapy straight after chemotherapy, rather than waiting for relapse, lengthened survival by about seven months.
Backbone ribbon from PDB 5GRJ. RCSB PDB 5GRJ. The ribbon widens where the chain is folded into a regular pattern and narrows where it is a loose loop.
Fully human IgG1 anti-PD-L1 with intact Fc (ADCC-capable). Connects to PD-L1.
1.Binds PD-L1 on tumour and myeloid cells
Given by infusion or injection in a clinic or hospital outpatient department, so it is a Part B drug: Medicare pays 80% after the Part B deductible and the patient owes 20% coinsurance, uncapped in Original Medicare unless a Medigap policy applies.
Covered under the medical benefit with prior authorisation confirming diagnosis, biomarker status and line of therapy; site-of-care policies may steer infusions away from hospital outpatient departments.
20% Part B coinsurance on a high-cost infusion adds up quickly: Medigap Plan G or N, Medicare Advantage maximum out-of-pocket, Medicaid dual eligibility, or a charity fund are the usual buffers.
Sources: Medicare.gov: Chemotherapy · Medicare.gov: Prescription drugs (outpatient, Part B). Not medical or financial advice; verify with your plan.
Sources: NICE TA788 · SMC advice: avelumab. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
Treatment of adults and pediatrics patients 12 years and older with metastatic merkel cell carcinoma (MCC)
Accelerated approval on a surrogate endpoint, with a confirmatory trial required.
Locally advanced or metastatic urothelial carcinoma following diease progression on platinum-containing chemotherapy or disease progression within 12 months of neoadjuvant or adjuvant treatment with platinum-containing chemotherapy
Accelerated approval on a surrogate endpoint, with a confirmatory trial required.
Locally advanced or metastatic urothelial carcinoma following diease progression on platinum-containing chemotherapy or disease progression within 12 months of neoadjuvant or adjuvant treatment with platinum-containing chemotherapy
Confirmed: the accelerated approval of 2017 converted to traditional approval 3.1 years after it was granted.
Treatment of adults and pediatrics patients 12 years and older with metastatic merkel cell carcinoma (MCC)
Confirmed: the accelerated approval of 2017 converted to traditional approval 6.5 years after it was granted.
| Region | Year | Indication |
|---|---|---|
| US | 2017 | Merkel cell carcinoma; urothelial cancer after platinum (accelerated) |
| US | 2020 | Maintenance after first-line platinum in advanced urothelial cancer |
| Adverse event | Any grade | Grade 3+ |
|---|---|---|
| Fatigue | 18% | - |
| Pruritus | 17% | - |
| Hypothyroidism | 12% | - |
| Immune-related grade 3+ | - | 7% |
Events listed without rates were not read from a primary source; see the label. Blank cells mean the figure was not sourced, not that it is zero.
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For patients who still receive platinum chemotherapy first, avelumab maintenance rather than observation is the standard next step. Where enfortumab vedotin plus pembrolizumab is available first line, this sequence is used less.
Avelumab is a chemotherapy-sparing option for single-agent-resistant gestational trophoblastic neoplasia, particularly where the alternative is combination chemotherapy.
Query for this drug: (TITLE:"Avelumab" OR ABSTRACT:"Avelumab" OR TITLE:"Bavencio" OR ABSTRACT:"Bavencio") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Avelumab, not a curated reading list.
Shares Merkel cell polyomavirus (MCPyV) status, JAVELIN Merkel 200, Merkel cell carcinoma, Immune checkpoint inhibitors.
Shares Merkel cell polyomavirus (MCPyV) status, JAVELIN Merkel 200, Merkel cell carcinoma, Immune checkpoint inhibitors.
Shares JAVELIN Bladder 100, PD-L1, Renal cell carcinoma, Bladder & urothelial cancer.
Shares A-BRAVE, Early triple-negative breast cancer, Triple-negative breast cancer (TNBC), Immune checkpoint inhibitors.
Shares A-BRAVE, Early triple-negative breast cancer, Triple-negative breast cancer (TNBC), Immune checkpoint inhibitors.
Shares Merck KGaA (EMD Serono), Pfizer (incl. Seagen), PD-L1, Immune checkpoint inhibitors.
Shares Low-risk gestational trophoblastic neoplasia (FIGO score 0 to 6), Gestational trophoblastic neoplasia, High-risk gestational trophoblastic neoplasia (FIGO score 7 or more, including ultra-high-risk).
Shares Merkel cell polyomavirus (MCPyV) status, Oncogenic viruses, Merkel cell carcinoma, Immune checkpoint inhibitors.