Immune checkpoint inhibitors in bladder cancer therapy: the experience with avelumab

Abstract

Immune checkpoint inhibitors have revolutionized the treatment of urothelial carcinoma. They are now part of the standard of care for locally advanced or metastatic urothelial carcinoma. Maintenance therapy with avelumab has been found to be the most effective compared to other immune checkpoint inhibitors. To date, platinum-containing chemotherapy followed by maintenance therapy with avelumab is the only regimen that has significantly improved overall survival in patients with advanced bladder cancer. The article presents the experience of maintenance therapy with avelumab on the example of 3 clinical cases of patients with inoperable forms of urothelial carcinoma. The experience of treating 3 patients who achieved stabilization with standard chemotherapy and received maintenance therapy with avelumab was retrospectively analyzed. The age of the patients ranged from 66 to 79 years, the study included two men and one woman. In two cases, muscle-invasive bladder cancer was initially verified, in one – progression 7 years after the start of treatment for non-muscle-invasive bladder cancer. Only in one of the cases, the volumetric formation of the bladder was radically removed, while distant metastases were detected 20 months after the operation, the rest of the patients did not receive radical treatment. The general condition allowed all patients to receive a full course of platinum-containing chemotherapy (gemcitabine + cisplatin or gemcitabine + carboplatin), partial remission was achieved. Maintenance immunotherapy with avelumab was started within a month of completion of chemotherapy. The duration of maintenance therapy currently ranges from 3 to 17 months; stabilization of the oncological process has been achieved in all cases. No clinically significant adverse side effects were noted in any of the cases. Our experience of maintenance immunotherapy with avelumab corresponds to world practice and illustrates the efficacy and safety of this drug.