Efficacy of Maintenance Avelumab After Chemotherapy in Advanced Urothelial Carcinoma - Expert Commentary

The standard of care first-line treatment for advanced urothelial carcinoma (aUC) is platinum-based chemotherapy, followed by avelumab (anti-PD-L1), for maintenance treatment in patients without progression. The JAVELIN trial confirmed that maintenance avelumab was associated with significantly prolonged overall survival (OS) and progression-free survival (PFS). Bakaloudi et al. set out to characterize clinical outcomes of switch maintenance avelumab in a real-world cohort of patients with aUC.

The retrospective cohort consisted of 108 patients, among whom the median age was 69 years. Most patients were male (80.6%) and had received cisplatin-based chemotherapy (65.7%). The median time from initiation of avelumab maintenance therapy to the final follow-up was 8.8 months. The median interval between the last dose of chemotherapy and avelumab initiation was six weeks. At endpoint analysis, 44.4% of patients were still on avelumab, while the remaining patients had discontinued treatment, with 76.7% of all patients experiencing progression. A small proportion of patients (10%) discontinued treatment due to treatment-related adverse events. At the last follow-up, 70.3% of patients were alive, with a median PFS of 9.6 months (95% CI, 7.5-12.1) and a landmark OS rate of 72.5% (95% CI, 63.2%-83.1%) at 1 year. The median OS was not reached. Patients with liver metastases at the time of chemotherapy initiation had shorter PFS than patients without liver metastases (HR = 2.32; 95% CI, 1.17-4.59). Complete response and partial response to avelumab maintenance were observed in 17.6% and 11.1% of patients, respectively.

The reported survival outcomes among a heterogeneous cohort of aUC patients receiving avelumab maintenance treatment are highly encouraging and confirm findings from the JAVELIN trial in a real-world setting. An outstanding question to be investigated is whether the number or the regimens of the initial chemotherapy cycles affect outcomes of maintenance avelumab. A deeper understanding of the biological mechanisms underlying response to maintenance avelumab compared to combinations of immunotherapy and chemotherapy is critical for designing more effective sequential or combination therapies for patients with metastatic UC.

Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine


  1. Bakaloudi DR, Talukder R, Lin GI, et al. Response and Outcomes of Maintenance Avelumab After Platinum-Based Chemotherapy (PBC) in Patients With Advanced Urothelial Carcinoma (aUC): "Real World'' Experience [published online ahead of print, 2023 Jun 20]. Clin Genitourin Cancer. 2023;S1558-7673(23)00147-7. doi:10.1016/j.clgc.2023.06.008
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