Considering Practice-Changing Maintenance Options in Bladder Cancer

Petros Grivas, MD, PhD, professor in the Clinical Research Division and medical director of Local/Regional Outreach and the International Program at Fred Hutchinson Cancer Center and professor in the Division of Hematology and Oncology at University of Washington School of Medicine, discusses the JAVELIN Bladder 100 trial (NCT02603432) in patients with advanced bladder cancer.

The JAVELIN Bladder 100 trial established avelumab (Bavencio) as a standard switch maintenance therapy, according to Grivas. It showed significant survival benefit for patients who achieve disease control with initial platinum-based chemotherapy when initially presented at the American Society of Clinical Oncology (ASCO) Annual Meeting in 2020.

For the majority of such patients, this maintenance therapy is the standard of care after chemotherapy. However, Grivas notes contraindications like active autoimmune disease require shared decision-making on an individual basis.

TRANSCRIPTION

0:10 | There's so much evolution and rapid change in the frontline treatment of advanced metastatic urothelial carcinoma. If we go chronologically, we have 3 practice-changing trials in this setting. Of course, the data have really shaped the way we treat patients in this disease setting. I would start chronologically in 2020 in June during the pandemic. We had the virtual plenary session at ASCO 2020 with my friend Tom Powles, myself, and others, we presented data from the JAVELIN Bladder 100 trial. Very quickly, to remind the audience, that trial was practice changing and established avelumab as switch maintenance immunotherapy for patients who already achieved disease control, response, or stable disease with platinum-based chemotherapy, for example, with gemcitabine/cisplatin or gemcitabine/carboplatin.

1:05 | That trial showed that if patients had started with chemotherapy first, again gemcitabine/cisplatin or gemcitabine/carboplatin, someone can extrapolate—it was not part of this trial—but can extrapolate with DDMVAC [dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin] with growth factor support. If any of the above regimens achieve complete or partial response, or stable disease, switch maintenance avelumab is the standard of care as maintenance therapy for those patients. That trial, JAVELIN Bladder 100, showed significant overall survival benefit and progression-free survival benefit that I think should be considered and has been practice changing.

1:43 | Of course, there could be some contraindication to immunotherapy, more generically speaking, for example, patients with active autoimmune disease, on immunosuppressive therapy. These are individual scenarios and can inform shared decision making, one by one, but I think for the vast majority of patients who achieve disease control, a response, or stable disease with platinum-based chemotherapy, avelumab maintenance is the standard of care in this particular setting.