Avelumab in locally advanced or metastatic urothelial carcinoma.

Outcomes for patients with advanced or metastatic urothelial carcinoma (UC) remain poor. Targeting the programmed death ligand 1 (PD-(L)1) immune checkpoint pathway has emerged as a useful target in patients with UC. Avelumab is a PD-L1 inhibitor, resulting in restoration of a cytotoxic, antitumour T cell response. Results from the JAVELIN bladder 100 trial has resulted in a new standard of care of platinum-based chemotherapy sequenced by maintenance avelumab in advanced or metastatic UC.

This review covers the clinical evidence for avelumab in UC. This includes the maintenance approach with avelumab, which has become standard of care, following platinum-based chemotherapy.

Immune checkpoint inhibitor treatment in metastatic UC holds much promise, but has not been optimised. First line maintenance avelumab is an attractive option for these patients. Future research will significantly change the landscape of treatment in the near future.

Article highlights Platinum-based chemotherapy is the standard of care first-line treatment for locally advanced or metastatic urothelial carcinomaPFS and OS for front line chemotherapy are limited by chemotherapy resistanceResults from randomised trials show front-line immunotherapy is not superior to chemotherapy in advanced or metastatic UCCombinations of ICIs with chemotherapy have not been successfulSequencing chemotherapy and first line maintenance avelumab in those patients not progressing on chemotherapy appears attractive for patients.Ongoing research is likely to significantly change the landscape of treatment in the near future.

Expert review of anticancer therapy. 2022 Jan 11 [Epub ahead of print]

Francesca Jackson-Spence, Bernadett Szabados, Charlotte Toms, Yu-Hsuen Yang, Christopher Sng, Thomas Powles

Queen Mary University of London Ringgold standard institution, London, UK., Barts Health NHS Trust Ringgold standard institution, St Bartholomew's Hospital West Smithfield London, London, UK.

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