4-weekly avelumab plus axitinib in patients with metastatic renal cell carcinoma

Why Fewer Hospital Visits Matter

For people living with advanced kidney cancer, modern drug combinations have improved survival but often at the cost of frequent trips to the hospital for intravenous treatments. Those visits are tiring, disruptive to daily life, and expensive for health services. This study asks a simple but important question: can one of these drugs, a cancer immunotherapy called avelumab, be given less often—once every four weeks instead of every two—without sacrificing how well the treatment works?

Two Drugs Working Together

Standard first-line care for metastatic renal cell carcinoma (kidney cancer that has spread) often combines two types of medicines. One is an immunotherapy drug that helps the body’s own defenses recognize and attack cancer cells. The other is a targeted pill that blocks signals helping tumors grow new blood vessels. In this case, the team studied avelumab, an immune “checkpoint” blocker given by drip, paired with axitinib, a tablet that interferes with blood vessel growth in tumors. This combination is already approved and known to shrink tumors and delay their growth compared with an older drug, but avelumab is usually given every two weeks, which means a high treatment burden over many months or years.

Testing a Slower Rhythm

During and after the COVID-19 pandemic, doctors at two large cancer centers in the United Kingdom began adjusting how often they gave avelumab in everyday practice. They looked back at 94 people with untreated metastatic kidney cancer who all received avelumab plus axitinib but at some point moved to a schedule of avelumab every four weeks. One group started the four-week schedule right away. The other group began with the usual two‑week schedule and later switched to four‑weekly infusions once scans showed their cancer was stable or shrinking and they felt well enough. The researchers then compared how long patients lived without their disease getting worse, how many had tumor shrinkage, and what side effects occurred.

Results That Match Standard Care

Among patients who received four‑weekly avelumab from the start, just over half had their tumors shrink, and the cancer typically did not worsen for about 22 months. Survival at one and two years was similar to what has been reported in previous large trials where avelumab was given every two weeks. Side effects looked much the same as before: some patients needed their axitinib dose reduced because of problems like high blood pressure, diarrhea, or fatigue, and only a small number required strong steroid treatment for immune‑related complications. In the group that switched later to four‑weekly dosing, outcomes were even better, reflecting the fact that these patients had already shown that their disease responded well to treatment before changing schedule.

Balancing Benefit, Burden, and Cost

The study fits into a wider movement to fine‑tune immunotherapy dosing so that patients are not overtreated. Similar drugs targeting the same immune pathways are already approved for use at longer intervals. Laboratory studies suggest that even when the drug itself clears from the bloodstream, its effect on immune cells can persist for weeks, supporting the idea that less frequent dosing may be enough. If effective, extended‑interval schedules could reduce the strain of repeated hospital visits, lessen the workload on infusion units and pharmacies, and help health systems save substantial drug costs—important considerations when a year of treatment can cost tens of thousands of pounds.

What This Means Going Forward

Because this work relies on looking back at routine clinic records rather than on a randomized trial, there are important limits. Doctors’ judgments rather than strict trial rules guided how responses and side effects were recorded, and the group included a relatively high proportion of patients with more favorable disease. Even so, the similar cancer control and safety seen with four‑weekly avelumab strongly suggest that many patients may not need such frequent infusions to benefit. The authors conclude that it is time to test this approach more rigorously in prospective clinical trials. If confirmed, a simple change in timing—spreading out avelumab doses to once a month—could help people with advanced kidney cancer spend less time in the hospital while maintaining the gains modern therapy has brought.

Citation: Vasudev, N.S., Aleem, U., Humphries, K. et al. 4-weekly avelumab plus axitinib in patients with metastatic renal cell carcinoma. BJC Rep 4, 23 (2026). https://doi.org/10.1038/s44276-026-00224-y

Keywords: metastatic kidney cancer, immunotherapy dosing, avelumab and axitinib, treatment schedule, quality of life