Extending the Benefits of Avelumab Maintenance in Urothelial Carcinoma

Commentary
Video

Ongoing research may clarify the potential benefit of avelumab when administered in combination with other agents in advanced urothelial carcinoma.

Joaquim Bellmunt, MD, PhD, spoke with CancerNetwork® at the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting about ongoing research to further investigate treatment with avelumab (Bavencio) for patients with advanced urothelial carcinoma and low tumor burden. He discussed these next steps in the context of findings from the phase 3 JAVELIN Bladder 100 trial (NCT02603432) that he presented at the meeting, which supported the efficacy and manageable toxicity profile of avelumab in this patient population.

Bellmunt, an associate professor at Harvard Medical School and director of the Bladder Cancer Center at the Genitourinary Oncology Program of Dana-Farber Cancer Institute, said that other ongoing studies aim to explore the potential benefit of maintenance avelumab when administered in combination with agents such as ATR inhibitors. These combination therapies might overcome resistance mechanisms in tumors that may limit the efficacy of avelumab monotherapy in some patients.

Transcript:

Based on the benefits that the JAVELIN Bladder 100 trial showed, maintenance immunotherapy with avelumab provides a survival advantage. There are several ongoing trials adding another drug to avelumab—for example, adding a MET inhibitor, TKIs, or other types of immunotherapy. It makes sense because we [usually] start using drugs as monotherapy, and we know that when [we use them] in combination, we can get additional benefit.

There are several trials exploring the concept of maintenance avelumab while adding some other drugs to improve the benefit. Also, there are studies with patients who [progress on] immunotherapy [in which they] keep receiving the immunotherapy while adding a rescue agent like an anti-OX40 agent or an ATR inhibitor. It seems that might overcome the resistance mechanism that may not allow that drug to be effective.

We know that immunotherapy is not working by killing cancer cells. It works in the microenvironment and changes the immune system. If we are able to rescue the resistance mechanism with other drugs, that's one of the aims of the avelumab development.

Reference

Bellmunt J, Powles T, Park SH, et al. Avelumab first-line maintenance (1LM) for advanced urothelial carcinoma (aUC): Long-term outcomes from JAVELIN Bladder 100 in patients (pts) with low tumor burden. J Clin Oncol. 2024;42(suppl 16):4566. doi:10.1200/JCO.2024.42.16_suppl.4566

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