Avelumab first-line maintenance in locally advanced or metastatic urothelial carcinoma: Applying clinical trial findings to clinical practice

Although urothelial carcinoma (UC) is considered a chemotherapy-sensitive tumor, progression-free survival and overall (OS) are typically short following standard first-line (1L) platinum-containing chemotherapy in patients with locally advanced or metastatic disease. Immune checkpoint inhibitors (ICIs) have antitumor activity UC favorable safety profiles compared chemotherapy; however, trials of 1L ICI monotherapy + combinations not yet shown improved OS vs alone. In addition to direct cytotoxicity, has potential immunogenic effects, providing rationale for assessing ICIs as switch-maintenance therapy. the JAVELIN Bladder 100 phase 3 trial, avelumab administered maintenance best supportive care (BSC) significantly prolonged BSC alone that had progressed (median OS, 21.4 14.3 months; hazard ratio, 0.69 [95% CI, 0.56–0.86]; P = 0.001). Efficacy benefits were seen across various subgroups, including recipients cisplatin- carboplatin-based chemotherapy, PD-L1+ PD-L1? tumors, diverse characteristics. Results from led approval therapy chemotherapy. Avelumab also included treatment guidelines level 1 evidence. This review summarizes data supported these developments discusses practical considerations administering clinical practice, patient selection management.