Dr. Bellmunt on maintenance avelumab for advanced urothelial carcinoma

In this video, Joaquim Bellmunt, MD, PhD, highlights the background and key findings from the study, “Avelumab first-line maintenance (1LM) for advanced urothelial carcinoma (aUC): Long-term outcomes from JAVELIN Bladder 100 in patients (pts) with low tumor burden,” which was presented at the 2024 American Society for Clinical Oncology Annual Meeting in Chicago, Illinois. Bellmunt is an associate professor at Harvard Medical School and the director of the Bladder Cancer Center of the Genitourinary Oncology Program at Dana-Farber Cancer Institute in Boston, Massachusetts.

Video Transcript:

JAVELIN 100 is a trial that was already published in the New England Journal, with level 1 evidence of survival benefit. [It led to] the approval of avelumab maintenance in the management of first-line metastatic bladder cancer patients. This trial was randomizing patients that received platinum-based therapy if they did not progress to receive immunotherapy or observation. It was shown that adding maintenance immunotherapy with avelumab improved the survival, and then this became a new standard of care in first-line. Since this trial was published, 2 additional trials with level 1 evidence have been published. So, we have at least now 3 options for treating in first-line metastatic bladder cancer patients.

Now, this trial has a medium follow-up of 38 months. We have updated the benefits of adding avelumab maintenance in patients that are not progressing with platinum-based therapy. In addition, we have been doing some subgroup analyses that were not planned because these trials allow different types of patients: metastatic with nonvisceral metastasis, lymph nodes, and whatever. What we have done is we have analyzed, now that the trial has long-term follow-up, the benefit that you can see giving maintenance avelumab in patients with low tumor burden. The low tumor burden was defined as patients having nonvisceral metastases, patients having lymph node only disease, or patients having pelvic and retroperitoneal lymph nodes. What we have seen analyzing the results of this group of patients with low tumor burden is that the benefit of avelumab is seen. We can see that the median survival is going beyond 31 months, meaning that patients with a low tumor burden are benefiting. They see more benefit when receiving maintenance avelumab than the group itself. So, the median survival in the overall group was 21 months, it went up to 24 with follow-up, and now we see this median overall survival of 31 months.

This transcription has been edited for clarity.