A real-world study shows modest uptake of avelumab maintenance following its US approval for advanced or metastatic urothelial carcinoma, despite its proven survival benefit. The study was published in JAMA Network Open.

The study included 3507 patients with advanced or metastatic urothelial cancer who initiated first-line therapy, including 2340 treated before avelumab maintenance was approved and 1167 treated after it was approved.

In the 22 months after approval, 20.4% of patients treated with first-line chemotherapy and 24.3% of maintenance-eligible patients received maintenance avelumab.

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The approval of avelumab maintenance was significantly associated with a 9.9% increase in the use of first-line carboplatin-based chemotherapy but no change in the use of first-line cisplatin-based chemotherapy or first-line immune checkpoint inhibitor therapy. For first-line immunotherapy, 42.8% of patients received pembrolizumab or atezolizumab.

“The limited use of immunotherapy in the maintenance setting stands in contrast to the rapid adoption of immunotherapy in the first-line setting (ie, pembrolizumab and atezolizumab), which could be due to limited clinician awareness of maintenance immunotherapy and/or patient preferences against long-term treatment after response to initial chemotherapy,” the investigators wrote.

“Our finding of higher treatment starts with carboplatin-based chemotherapy in the postmaintenance period suggests an increasing preference by clinicians of a treatment strategy that provides patients an opportunity for 2 effective treatment options. Finally, the high proportions of first-line immunotherapy use in both the premaintenance and postmaintenance periods may reflect its label indication for patients with advanced urothelial cancer as ineligible for any platinum-containing chemotherapy.”

Disclosures: This research was supported by Merck & Co. Please see the original reference for a full list of disclosures.


Mamtani R, Zhang H, Parikh RB, et al. Uptake of maintenance immunotherapy and changes in upstream treatment selection among patients with urothelial cancer. JAMA Netw Open. Published online April 14, 2023. doi:10.1001/jamanetworkopen.2023.8395

This article originally appeared on Renal and Urology News