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Published in Bladder Cancer

Expert Opinion / Cases · May 07, 2021

Metastatic BC

Shafi Alam


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  • Guru Sonpavde

    I would recommend avelumab switch-maintenance therapy now (within 4-10 weeks of last chemotherapy). Avelumab demonstrated improved overall survival (OS) as switch maintenance therapy in the JAVELIN-Bladder-100 phase III trial regardless of tumor PD-L1 expression in patients with metastatic urothelial carcinoma (mUC) who had stable or responding disease after 4-6 cycles of platinum-based first line chemotherapy (median OS 21.4 vs 14.3 months; HR, 0.69; 1-sided P = .0005). Switch maintenance avelumab also ensures early delivery of avelumab to a large fraction of patients when compared with the paradigm of administering a PD1/L1 inhibitor to those with progressive disease following a break from systemic therapy. The switch maintenance paradigm appeared to benefit patients regardless of tumor PD-L1 status, prior cisplatin vs carboplatin, quality of response (CR, PR, SD) and sites of metastasis (despite some trends, none of the sub-analyses were powered for definitive results). It is unclear if avelumab can be safely discontinued without compromising outcomes after a specific duration (especially in those with CR/PR) and a randomized ALLIANCE led study is evaluating this issue (NCT04637594) and should be supported.

  • Jun 17, 2021

    Pending Moderator approval.

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