Anti-programmed cell death ligand 1 (PD-L1)/programmed cell death 1 antibodies have shown clinical activity in platinum-treated metastatic urothelial carcinoma, resulting in regulatory approval of several agents, including avelumab (anti-PD-L1).
We report ≥2-year follow-up data for avelumab treatment and exploratory subgroup analyses in patients with urothelial carcinoma.
Patients with previously treated advanced/metastatic urothelial carcinoma, pooled from two cohorts of the phase Ib JAVELIN Solid Tumor trial, received avelumab 10 mg/kg every 2 weeks until disease progression, unacceptable toxicity or withdrawal. End points included best overall response and progression-free survival (PFS) per RECIST V.1.1, overall survival (OS) and safety. Post hoc analyses included objective response rates (ORRs) in subgroups defined by established high-risk/poor-prognosis characteristics and association between time to response and outcome.
249 patients received avelumab; efficacy was assessed in 242 postplatinum patients. Median follow-up was 31.9 months (range 24-43), and median treatment duration was 2.8 months (range 0.5-42.8). The confirmed ORR was 16.5% (95% CI 12.1% to 21.8%; complete response in 4.1% and partial response in 12.4%). Median duration of response was 20.5 months (95% CI 9.7 months to not estimable). Median PFS was 1.6 months (95% CI 1.4 to 2.7 months) and the 12-month PFS rate was 16.8% (95% CI 11.9% to 22.4%). Median OS was 7.0 months (95% CI 5.9 to 8.5 months) and the 24-month OS rate was 20.1% (95% CI 15.2% to 25.4%). In post hoc exploratory analyses, avelumab showed antitumor activity in high-risk subgroups, including elderly patients and those with renal insufficiency or upper tract disease; ORRs were numerically lower in patients with liver metastases or low albumin levels. Objective response achieved by 3 months versus later was associated with longer OS (median not reached (95% CI 18.9 months to not estimable) vs 7.1 months (95% CI 5.2 to 9.0 months)). Safety findings were consistent with previously reported 6-month analyses.
After ≥2 years of follow-up, avelumab showed prolonged efficacy and acceptable safety in patients with platinum-treated advanced/metastatic urothelial carcinoma, including high-risk subgroups. Survival appeared longer in patients who responded within 3 months. Long-term safety findings were consistent with earlier reports with avelumab treatment in this patient population.
Journal for immunotherapy of cancer. 2020 Oct [Epub]
Andrea B Apolo, John A Ellerton, Jeffrey R Infante, Manish Agrawal, Michael S Gordon, Raid Aljumaily, Theodore Gourdin, Luc Dirix, Keun-Wook Lee, Matthew H Taylor, Patrick Schöffski, Ding Wang, Alain Ravaud, Juliane Manitz, Gregory Pennock, Mary Ruisi, James L Gulley, Manish R Patel
Investigator Genitourinary Malignancies Branch NIH Lasker Clinical Research Scholar Head, Bladder Cancer Section, Center for Cancer Research National Cancer Institute. ., Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA., Nevada Cancer Research Foundation, Las Vegas, Nevada, USA., Sarah Cannon Research Institute, Nashville, Tennessee, USA., Associates in Oncology, Rockville, Maryland, USA., Hematology/Oncology, The University of Oklahoma Stephenson Cancer Center, Oklahoma City, Oklahoma, USA., Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA., Department of Medical Oncology, Sint-Augustinus Hospital Oncology Centre, Antwerp, Belgium., Department of Internal Medicine, Seoul National University College of Medicine, Seongnam, Republic of Korea., Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium., Henry Ford Cancer Institute, Detroit, Michigan, USA., Department of Medical Oncology, Bordeaux University Hospital, Bordeaux, France., EMD Serono Research & Development Institute, Inc, Billerica, Massachusetts, USA; a business of Merck KGaA, Darmstadt, Germany., EMD Serono, Inc, Rockland, Massachusetts, USA; a business of Merck KGaA, Darmstadt, Germany., Hematology Oncology, Oregon Health & Science University, Portland, Oregon, USA., Florida Cancer Specialists/Sarah Cannon Research Institute, Sarasota, Florida, USA.