Avelumab has the highest risk of infusion related reactions (IRRs) amongst all immune checkpoint inhibitors.
Acetaminophen and antihistamine (e.g., diphenhydramine, cetirizine, loratadine, etc.) must be administered prior to each of the first 4 doses, then as required thereafter.
Avelumab is the only immune checkpoint inhibitor with antibody dependent cell-mediated cytotoxicity (ADCC) properties, which may support natural killer cell-mediated direct tumour cell lysis.
ADCC properties are also hypothesized to contribute to the increased risk of IRRs with avelumab.