Switch Maintenance Therapy in Urothelial Cancers

By Lauren Bentivegna - April 20, 2023

Dr. Eun-mi Yu and colleagues at the Inova Schar Cancer Institute conducted a review to summarize the progression of switch maintenance therapies for metastatic urothelial carcinoma (mUC) and their current use.

Metastatic urothelial carcinoma of the bladder typically has a very low chance of recovery. To discover the best and most effective treatment, doctors have previously compared the different forms of first-line treatment, such as chemotherapy with gemcitabine and cisplatin (GC); or methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC), which can also be given in a dose-dense fashion (ddMVAC). However, none of these treatments showed a significant overall survival (OS) rate.

Immune checkpoint inhibitors, such as avelumab, are life-extending maintenance therapies for advanced mUC. However, the first line of treatment for mUC, platinum-based chemotherapy, only has a 50% response rate, causes rapid progression of disease, causes treatment toxicity with subsequent lines of therapy, and causes a limited life expectancy in patients with progressive mUC. Also, it only controls the disease temporarily, even after 3-6 cycles. Second-line treatments such as ICIs, antibody-drug conjugates (ADCs), and tyrosine kinase inhibitors (TKIs) have been recently showing progress in eligible patients after they have been treated with platinum-based chemotherapy.

Platinum-based therapy with close observation until the disease evidently progresses has been the standard method of treatment for several years. It was not until the results from The JAVELIN Bladder 100 trial, published in 2020, that a maintenance strategy could be proven to be more beneficial than best supportive care (BSC) accompanied by first-line platinum-based therapy.

The JAVELIN Bladder 100 trial compared outcomes between patients who received avelumab with BSC and BSC by itself. BSC included antibiotic therapy, pain management, nutritional support, hydration, and palliative radiation therapy for those with solitary lesions. This trial took place across multiple different study centers with 700 patients enrolled with locally advanced or metastatic UC.

The 700 patients participating in the trial were split into two even groups. One group started avelumab 10 mg/kg intravenously every 2 weeks along with BSC while the others started BSC alone within 4-10 weeks of completing chemotherapy.

The trial showed that avelumab accompanied by BSC significantly extended the patients’ progression free survival and OS rate compared to patients who were only treated with BSC.

For more information regarding mUC and maintenance therapy, check out the Treatment section of Cancer Nursing Today.


The role of switch maintenance therapy in urothelial cancers – PMC

Definition of progression-free survival – NCI Dictionary of Cancer Terms

Definition of overall survival – NCI Dictionary of Cancer Terms