Avelumab

Side Effect

Management

Infusion-related reaction

This sometimes occurs during the first few doses.

This is usually mild or moderate, but rarely can be more severe.

• For the first 4 infusions, you will be given an anti-allergy medication and Paracetamol to prevent infusion reactions. These medications may not be required from the 5^th infusion onwards if you do not have an infusion reaction.
• Inform the nurse immediately if you experience any of the following during the infusion:
  • Flu-like symptoms such as fever, chills or dizziness, headache, feeling warm or flushed
  • Red, warm, and itchy bumps on the skin
  • Swelling of the lips, tongue, or throat
  • Breathlessness, wheezing, cough or sudden difficulty breathing
  • Back pain or chest pain
• If you do have a reaction, this is usually treated by slowing or stopping the drip until the reaction is over. Future infusions may also be given at a slower rate.

Skin rash

• You may experience mild skin rashes that may be itchy.
• Avoid hot showers. Use cool or lukewarm water to bathe.
• Apply a moisturizer to areas with dry skin.
• There are rare cases where the skin rash is severe. Proceed to the A&E Department immediately if the rash is painful, blistering, or if it affects a large area of the body.

Muscle-aches and/or joint pain

Feeling tired

• It is normal to feel tired after treatment.
• Mild pain can be relieved by taking Paracetamol.
• Inform your doctor if you have any severe pain in the muscles or joints that affect walking or sleeping.

Diarrhoea (loose stools)

It is common to have mild diarrhoea after treatment.

• Drink more water to prevent dehydration.
• Rarely, colitis (inflammation of the bowels) may occur and cause severe diarrhea. Proceed to the A&E department if you experience abdominal pain, loose stools more than 4 times a day, mucus or blood in stools, or if your stools appear black and sticky.

Hormonal abnormalities

Inflammation of various hormone glands (such as the pituitary, thyroid, pancreas and adrenal glands) may occur

This may affect the production of certain hormones in your body

• Some hormone levels can be monitored with regular blood tests.
• Some of the signs and symptoms include the following:
  • Headaches that do not go away
  • Vision problems
  • Unusually fast heartbeat
  • Increased sweating
  • Extreme tiredness
  • Unusual weight gain or weight loss
  • Feeling cold all the time
  • Increased hunger or thirst
  • Increased urination
  • Dizziness or fainting
  • Changes in mood or behaviour
• Inform your doctor if any of these occurs.
• You may be given medication to treat your condition.

Pneumonitis (inflammation of the lungs)

• Please see a doctor if you experience shortness of breath or a dry cough that does not go away.

Liver problems

• Proceed to the A&E department immediately if you experience any:
  • Dark or tea-coloured urine
  • Pale or light-coloured stools
  • Yellowing of skin or eyes
  • Nausea, vomiting with loss of appetite
  • Severe stomach pain
• Keep your doctor informed about any supplements or over-the-counter medications that you take.

Kidney problems

• Proceed to the A&E department immediately if you are unable to pass urine or have an abnormal leg swelling.

Heart problems

• Proceed to the A&E department immediately if you experience signs of heart problems such as shortness of breath, difficulty breathing, chest pain, a fast heartbeat, or sudden swelling of legs.

Eye problems

• Inform your doctor if you experience any blurred vision, double vision, eye pain or redness, or any other problems with vision.

Exercise

Light exercise is recommended as it helps to improve mobility, balance, and even emotional well-being. Avoid strenuous exercise, and rest when you are feeling tired.

Medical and dental treatment

If you need to go to the hospital for any reason other than cancer, always inform the doctors and nurses that you are receiving anti-cancer treatment.

Talk to your cancer doctor if you think you need dental treatment. Always inform your dentist that you are receiving anti-cancer treatment.

Seek support if you feel overwhelmed

It is normal to feel fearful or worried about your condition.

Do not be afraid to talk about your concerns with your healthcare team or loved ones.

There may be resources and support available to help you.