Patient Eligibility for Maintenance Avelumab Points to Lack of 1L Treatments for la/mUC

At the 24th Annual Meeting of the Society of Urologic Oncology, Dr. Alicia K. Morgans, of the Dana-Farber Cancer Institute, presented the results of a retrospective, observational study on the number of patients with locally advanced or metastatic urothelial carcinoma (la/mUC) who are eligible for and have received maintenance avelumab in clinical practice in the United States.

First-line (1L) platinum-based chemotherapy (PBT) is commonly recommended for patients with la/mUC. Based on survival benefit versus best supportive care data from the JAVELIN Bladder 100 trial, maintenance avelumab is often recommended for patients who do not experience disease progression after receiving 1L PBT.

The study involved 336 patients with la/mUC. Data were collected via the Flatiron Health longitudinal electronic health record-derived database, comprised of de-identified patient-level structured and unstructured data. Patients received ≥1 dose of 1L PBT between April 2020 and January 2022. Maintenance avelumab eligibility, utilization, and patient disposition were assessed. Eligibility was defined as complete response, partial response, or stable disease after treatment with 1L PBT.

The median age of the patient group was 70.1 years; 72.6% of patients were male. A cisplatin-based regimen was utilized in 186 (55.4%) patients, while the remainder received a carboplatin-based regimen. A total of 181 (53.9%) patients were eligible for maintenance avelumab.

Of 138 patients who were ineligible to receive maintenance avelumab, the main reason was disease progression (71.7%; 99/138), followed by death during or after treatment with 1L PBT (28.3%; 39/138). Of the eligible patients, 37.0% (67/181) received maintenance avelumab, representing 19.9% (67/336) of the 1L PBT-treated population. In patients who initiated maintenance avelumab, the mean time to initiation from the end of 1L PBT was 1 month, and the duration of maintenance treatment was 5.5 months.

Almost half of all patients initiating 1L PBT were not eligible to undergo treatment with maintenance avelumab, mainly due to disease progression or death. More than 80% of the overall 1L PBT-treated patient population did not receive maintenance avelumab. This study highlights the need for further novel 1L treatments for patients with la/mUC.