Avelumab maintenance therapy following platinum-based chemotherapy is recommended as an alternative treatment in patients with locally advanced or metastatic urothelial carcinoma; however, real-world data are limited, and no predictive system has been established to identify suitable candidates for avelumab at the initiation of chemotherapy.
This retrospective study analyzed 324 patients with locally advanced or metastatic urothelial carcinoma who received platinum-based chemotherapy. Patients were divided into three groups: 130 who received avelumab (avelumab group), 58 who did not experience disease progression on chemotherapy within 4 cycles but did not receive avelumab (PBC-only group), and 136 who experienced disease progression on chemotherapy within 4 cycles (PBC-PD group). Oncological outcomes were compared among the groups, and a system for predicting the maintained response to chemotherapy for 4 or more cycles was explored.
The avelumab group had significantly longer overall survival than the other two groups. After propensity score matching, overall survival was significantly longer in the avelumab group than in the PBC-only group. Lymph node-only metastasis and a low neutrophil-to-lymphocyte ratio were identified as predictive factors for maintaining response to chemotherapy. Among patients with these two factors (favorable group), 81.1% maintained a response, and those who received avelumab maintenance therapy showed that the median overall survival was 33.4 months from initiation of chemotherapy.
The survival benefit of avelumab following chemotherapy compared to chemotherapy alone was confirmed. In the favorable group, avelumab following chemotherapy may be a valuable option if they are ineligible or unwilling to receive the preferred regimen.
International journal of urology : official journal of the Japanese Urological Association. 2026 Aug [Epub]
Yuto Matsushita, Yuki Kita, Shoichioro Mukai, Akira Joraku, Ikuo Kobayashi, Kei Daizumoto, Tomoyasu Sano, Shotaro Nakanishi, Jun Watanabe, Shingo Hatakeyama, Akihiro Goriki, Tatsuya Hazama, Naotaka Nishiyama, Keiichiro Mori, Hiroshi Kitamura, Takahiro Kimura, Yoshiyuki Matsui, Makito Miyake, Takashi Kobayashi, Teruo Inamoto, Japanese Urological Oncology Group
Department of Urology, Hamamatsu University School of Medicine, Shizuoka, Japan., Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan., Department of Urology, University of Miyazaki, Miyazaki, Japan., Department of Urology, Ibaraki Prefectural Central Hospital, Ibaraki, Japan., Department of Urology, Aichi Medical University, Nagakute, Aichi, Japan., Department of Urology, Tokushima University, Graduate School of Biomedical Sciences, Tokushima, Japan., Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan., Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan., Department of Urology, Toyooka Public Hospital, Toyooka, Hyogo, Japan., Department of Urology, Hirosaki University Graduate School of Medicine, Aomori, Japan., Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan., Department of Urology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan., Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Japan., Department of Urology, The Jikei University School of Medicine, Tokyo, Japan., Department of Urology, National Cancer Center Hospital, Tokyo, Japan., Department of Urology, Nara Medical University, Nara, Japan.