Clinical evidence and insights supporting the use of avelumab first‐line maintenance treatment in patients with advanced urothelial carcinoma in the Asia‐Pacific region

Abstract

Until recently, international and Asia‐specific guidelines for advanced urothelial carcinoma (UC) recommended first‐line (1L) platinum‐based chemotherapy, followed by second‐line (2L) anti‐PD‐1 or anti‐PD‐L1 immune checkpoint inhibitor (ICI) therapy where possible, or 1L ICI therapy in cisplatin‐ineligible patients with PD‐L1+ tumors. However, long‐term outcomes remain poor and only a minority of patients receive 2L therapy. The JAVELIN Bladder 100 trial—which assessed avelumab (anti‐PD‐L1 antibody) as 1L maintenance therapy plus best supportive care (BSC) versus BSC alone in patients with advanced UC that had not progressed with 1L platinum‐based chemotherapy—is the only phase 3 trial of ICI‐based treatment in the 1L setting to show significantly improved overall survival, and this treatment approach is now recommended in updated treatment guidelines. Available data from the trial suggest that efficacy and safety in patients enrolled in the Asia‐Pacific region were similar to findings in the overall population. In this review, we discuss the treatment of advanced UC, with a specific focus on studies in the Asia‐Pacific region, and summarize key findings supporting the use of avelumab 1L maintenance as a standard of care in this setting both in cisplatin‐eligible and cisplatin‐ineligible patients and irrespective of PD‐L1 status.

A cost‐effectiveness analysis of avelumab plus best supportive care versus best supportive care alone as first‐line maintenance treatment for patients with locally advanced or metastatic urothelial carcinoma in Taiwan

“…The analysis demonstrated the likely cost effectiveness of avelumab 1L maintenance as a standard of care in this setting both in cisplatin‐eligible and cisplatin‐ineligible patients and irrespective of PD‐L1 status in Taiwan. The use of avelumab 1L maintenance may be incorporated into current treatment guidelines for la/mUC 40,41 . Patients who are eligible for 1L platinum‐containing chemotherapy may be considered for avelumab 1L maintenance if they have not had disease progression following chemotherapy.…”

“…The use of avelumab 1L maintenance may be incorporated into current treatment guidelines for la/mUC. 40 , 41 Patients who are eligible for 1L platinum‐containing chemotherapy may be considered for avelumab 1L maintenance if they have not had disease progression following chemotherapy. Additionally, healthcare providers and policy makers may consider the cost‐effectiveness of avelumab when making decisions about treatment options and healthcare resource allocations.…”