Avelumab -Avelumab is a human monoclonal antibody.Avelumab is a human monoclonal antibody used in immunotherapy. It works by targeting a protein called PD-L1 (programmed death-ligand 1) on cancer cells, allowing the body's immune system to recognize and attack the cancer cells. This helps to enhance the body's natural defenses against cancer. Avelumab has been approved for the treatment of various types of cancer, including Merkel cell carcinoma and urothelial carcinoma. Description with Memonic

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Monoclonal Antibody
With Real Memonics
In
Primary Biliary Cholangitis
Avelumab
Drug induced Liver injury by Avelumab

2. Avelumab is a human monoclonal antibody to programmed cell death
ligand 1 (PD-L1), which acts as a checkpoint inhibitor and is used in the
immunotherapy of several forms of advanced or metastatic cancer.
Avelumab therapy has major side effects and particularly immune
related conditions, including acute hepatocellular and
cholestatic liver injury which can be serious and even life threatening.

3. Mechanism of Avelumab-Induced Liver Injury:
Feature Description
Cause Likely immunologically mediated
Response to Treatment
Usually at least partially responsive to corticosteroids
or immunosuppressive therapy
Evidence Biopsies show:
* In hepatocellular injury: necrosis and inflammatory
cell infiltration with cytotoxic CD8+ T cells in liver cells
(hepatocytes)
* In cholangiopathic injury: necrosis and inflammatory
cell infiltration with cytotoxic CD8+ T cells in bile duct
epithelial cells
Possible Explanation
Checkpoint inhibition by avelumab allows activation of
T cells against liver or bile duct cell surface antigens

4. Mechanism of action
Cause: When you take avelumab (a cancer treatment), it can sometimes trigger your
immune system to attack your liver cells or bile duct cells. This is likely because
avelumab works by "taking the brakes off" your immune system, allowing it to attack
cancer cells more aggressively. Unfortunately, sometimes it can also mistakenly attack
healthy tissues like your liver.

5. Symptoms: You might not experience any symptoms, but
sometimes people with avelumab-induced liver injury
have:
•Fatigue
•Nausea
•Loss of appetite
•Yellowing of the skin and eyes (jaundice)
•Dark urine
•Abdominal pain

6. Diagnosis: Doctors can diagnose this condition through
blood tests and liver biopsies.
Treatment: The good news is that most people respond
well to treatment with medications like corticosteroids or
immunosuppressants, which help calm down the
immune system and stop it from attacking the liver.

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13. beneficial role in cancer immunotherapy by breaking
immunological tolerance to cancer cell neo-antigens. In
several multicenter studies, avelumab therapy resulted
in objective responses in patients with advanced,
metastatic or unresectable malignant neoplasms, and a
proportion of patients had a long term remission.
Avelumab was approved for use in metastatic Merkel cell
carcinoma and advanced, refractory urothelial bladder
carcinoma in the United States in 2017, and was
subsequently approved for use in combination with
axitinib in advanced renal cell carcinoma. Avelumab is
available in single use 10 mL vials of 200 mg (20 mg/mL)
under the brand name Bavencio. The recommended dose
is 800 mg as an intravenous infusion every 2 weeks.
Premedication with acetaminophen and antihistamines is
recommended for the first 4 infusions.
As with most checkpoint inhibitors, side effects of
avelumab are common and can include fatigue,
headache, musculosketetal pain, arthralgia, abdominal
pain, diarrhea, nausea, vomiting, decreased appetite,
weight loss, fever, cough, dyspnea, pruritus, and rash.
Importantly, as a result of the immune enhancement,
between 15% and 30% of avelumab treated patients
develop immune related side effects, including