- The European Society for Medical Oncology (ESMO) has issued an update to its 2014 guidelines for the treatment of bladder cancer.
- ESMO recommends maintenance avelumab in patients with metastatic disease.
- Chemotherapy remains standard first-line treatment in patients with advanced disease.
- Platinum-containing combination chemotherapy is the standard of care for advanced or metastatic urothelial cancer.
- Gemcitabine with cisplatin/carboplatin is most widely used.
- Maintenance avelumab is recommended in patients who have not progressed on first-line platinum-based chemotherapy (4-6 cycles).
- Maintenance avelumab improved OS vs best supportive care (HR, 0.69; 95% CI, 0.56-0.86).
- The OS benefit was seen regardless of programmed death-ligand 1 (PD-L1) status, chemotherapy regimen given, and response to chemotherapy.
- Treatment was initiated within 10 weeks of completion of chemotherapy and was given until disease progression.
- Maintenance avelumab has not yet been approved by the European Medicines Agency.
- First-line pembrolizumab or atezolizumab is recommended in PD-L1-positive patients.