The introduction of immune checkpoint inhibitors over the last several years has improved the care of patients with metastatic urothelial cancer. Checkpoint inhibitors target the proteins PD-1 or PD-L1, blocking cancer cells from “turning off” the immune system. In the JAVELIN Bladder 100 trial, researchers found that maintenance therapy — cancer treatment that continues following initial treatment — with avelumab extended overall survival (median 21.4 months) compared with best supportive care alone (median 14.3 months) in patients with metastatic urothelial cancer that was stable or had responded to platinum-based chemotherapy. The study results represent the longest survival yet seen in advanced urothelial cancer and led to the approval of avelumab as a maintenance therapy in this patient population.  

For the first time, a study shows that starting chemotherapy immediately following surgery is beneficial for patients with cancer that has spread beyond the bladder, compared to delaying chemotherapy until the cancer returns. While survival is similar with either approach, immediate chemotherapy was associated with longer time until the cancer worsens and fewer side effects.

Additional research will explore whether certain subgroups of patients may benefit more from each approach.