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Continuing with the immunotherapy avelumab after chemotherapy had controlled advanced bladder cancer lengthened survival by about seven months compared with watching and waiting.
Phase 3 trial of 700 patients with unresectable locally advanced or metastatic urothelial carcinoma whose disease had not progressed on four to six cycles of platinum-based chemotherapy, randomised to avelumab maintenance plus best supportive care or supportive care alone.
Median overall survival was 21.4 months with avelumab against 14.3 months with supportive care (hazard ratio 0.69). The benefit was seen regardless of PD-L1 status and established switch maintenance immunotherapy as the standard after first-line chemotherapy until enfortumab vedotin plus pembrolizumab displaced chemotherapy in the first line.
For patients who still receive platinum chemotherapy first, avelumab maintenance rather than observation is the standard next step. Where enfortumab vedotin plus pembrolizumab is available first line, this sequence is used less.
Shares Muscle-invasive and advanced bladder cancer, New England Journal of Medicine.
Shares Avelumab, Muscle-invasive and advanced bladder cancer.
Shares Avelumab, Muscle-invasive and advanced bladder cancer.
Shares Muscle-invasive and advanced bladder cancer, New England Journal of Medicine.
Shares JAVELIN Bladder 100, Avelumab.
Shares Muscle-invasive and advanced bladder cancer, New England Journal of Medicine.