Maintenance immunotherapy in advanced urothelial cancer

Advanced urothelial carcinoma usually responds to platinum-based chemotherapy (CT), although overall survival (OS) and progression-free survival are typically short. Immunotherapy is a promising treatment strategy, but first-line benefits in platinum-eligible patients are limited, and its combination with first-line chemotherapy has not been shown to benefit OS. Maintenance with immunotherapy in patients with clinical benefit is a strategy that takes advantage of the immunogenic effects of CT, as well as its antitumor activity and safety. Avelumab is the only inhibitor approved for first-line maintenance in patients with locally advanced or metastatic urothelial carcinoma that has not progressed with platinum-based CT. International guidelines recommend first-line maintenance avelumab as the standard of care for locally advanced or metastatic urothelial carcinoma that has not progressed with first-line chemotherapy.