Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada.
Can J Urol. 2023 Aug;30(4):11633-11638.
For more than four decades, platinum-based chemotherapy regimens have served as the established standard-of-care for advanced urothelial carcinoma (aUC). However, advancements in our understanding of cancer biology and tumor microenvironment have reshaped the therapeutic landscape and prognosis of this incurable disease. Immune checkpoint inhibitors (ICIs) that target programmed cell death 1 (PD-1) and programmed cell death ligand 1 (PD-L1) are firmly established tools in aUC management, leading to enhanced life span and improved quality of life for patients. In patients who achieved stable disease or better following platinum-based chemotherapy, maintenance therapy with the PD-L1 antibody avelumab significantly enhanced overall survival (OS) by approximately 7 months compared to best supportive care in the phase 3 JAVELIN Bladder 100 trial. As a result, avelumab received FDA approval in June 2020 as a maintenance therapy for aUC patients treated with first-line platinum-based chemotherapy. Therefore, aUC care plans should incorporate maintenance avelumab into standard first-line treatment regimens for these patients. The objective of this brief article is to provide insight into the utilization of avelumab, identify patients who may benefit from this treatment, and review the methodology, advantages, potential side effects and their management.
四十多年来，铂类化疗方案一直是晚期尿路上皮癌（aUC）的既定标准治疗方法。然而，我们对癌症生物学和肿瘤微环境的理解的进步已经改变了这种无法治愈的疾病的治疗前景和预后。针对程序性细胞死亡蛋白 1（PD-1）和程序性细胞死亡配体 1（PD-L1）的免疫检查点抑制剂（ICI）是 aUC 管理中可靠的工具，为患者带来了更长的生存期和生活质量的改善。在接受铂类化疗后达到疾病稳定或更好的患者中，与最佳支持治疗相比，PD-L1 抗体avelumab 的维持治疗在 JAVELIN Bladder 100 三期试验中使总生存期（OS）延长了约 7 个月。因此，avelumab 于 2020 年 6 月获得 FDA 批准，作为接受一线铂类化疗的 aUC 患者的维持治疗药物。因此，aUC 护理计划应将 avelumab 纳入这些患者的标准一线治疗方案中。本文的目的是提供 avelumab 的应用见解，确定可能从这种治疗中受益的患者，并回顾其方法、优势、潜在副作用及其管理。
