Clinical Outcomes of Avelumab Maintenance Following Full-Dose, Reduced-Dose Cisplatin, or Carboplatin-Based Chemotherapy in Advanced Urothelial Carcinoma.
{"title":"Clinical Outcomes of Avelumab Maintenance Following Full-Dose, Reduced-Dose Cisplatin, or Carboplatin-Based Chemotherapy in Advanced Urothelial Carcinoma.","authors":"Nobuki Furubayashi, Jiro Tsujita, Azusa Takayama, Shin Nakashima, Motonobu Nakamura, Takahito Negishi","doi":"10.2147/RRU.S554029","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Avelumab maintenance therapy is a standard of care for patients with advanced urothelial carcinoma (UC) who achieve disease control following platinum-based chemotherapy. However, the influence of induction chemotherapy intensity on avelumab outcomes remains unclear.</p><p><strong>Materials and methods: </strong>This retrospective study included 26 patients with advanced UC who received avelumab maintenance after first-line platinum-based chemotherapy between March 2021 and June 2025. Patients were grouped by induction regimen: full-dose gemcitabine/cisplatin (GC), reduced-dose GC, or gemcitabine/carboplatin (GCarbo). Survival outcomes from the start of avelumab treatment and from chemotherapy initiation were analyzed using the Kaplan-Meier method and compared using the Log rank test.</p><p><strong>Results: </strong>The median patient age was 72 years, with a significant difference among groups (<i>P</i> < 0.01). The objective response rates to induction chemotherapy were 60.0% (full-dose GC), 80.0% (reduced-dose GC), and 45.5% (GCarbo) (<i>P</i>=0.458), with respective disease control rates during avelumab maintenance of 50.0%, 100.0%, and 54.5% (<i>P</i>=0.188). The median progression-free survival (PFS) values from avelumab initiation were 4.0, 12.1, and 5.7 months, respectively (<i>P</i>=0.636). The median overall survival (OS) values from avelumab initiation were 21.7, 18.6, and 18.4 months (<i>P</i>=0.587), while those from chemotherapy initiation were 28.8, 28.7, and 29.0 months (<i>P</i>=0.496), in the respective groups. No significant differences in PFS or OS were observed among the three groups or between the GC-based and GCarbo regimens.</p><p><strong>Conclusion: </strong>Avelumab maintenance showed comparable efficacy across the full-dose GC, reduced-dose GC, and GCarbo groups, highlighting the potential feasibility of personalized induction chemotherapy strategies. These findings may provide reassurance in clinical situations where full-dose cisplatin is not feasible due to patient frailty or renal dysfunction.</p>","PeriodicalId":21008,"journal":{"name":"Research and Reports in Urology","volume":"17 ","pages":"341-351"},"PeriodicalIF":2.7000,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12478201/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Research and Reports in Urology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2147/RRU.S554029","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Avelumab maintenance therapy is a standard of care for patients with advanced urothelial carcinoma (UC) who achieve disease control following platinum-based chemotherapy. However, the influence of induction chemotherapy intensity on avelumab outcomes remains unclear.
Materials and methods: This retrospective study included 26 patients with advanced UC who received avelumab maintenance after first-line platinum-based chemotherapy between March 2021 and June 2025. Patients were grouped by induction regimen: full-dose gemcitabine/cisplatin (GC), reduced-dose GC, or gemcitabine/carboplatin (GCarbo). Survival outcomes from the start of avelumab treatment and from chemotherapy initiation were analyzed using the Kaplan-Meier method and compared using the Log rank test.
Results: The median patient age was 72 years, with a significant difference among groups (P < 0.01). The objective response rates to induction chemotherapy were 60.0% (full-dose GC), 80.0% (reduced-dose GC), and 45.5% (GCarbo) (P=0.458), with respective disease control rates during avelumab maintenance of 50.0%, 100.0%, and 54.5% (P=0.188). The median progression-free survival (PFS) values from avelumab initiation were 4.0, 12.1, and 5.7 months, respectively (P=0.636). The median overall survival (OS) values from avelumab initiation were 21.7, 18.6, and 18.4 months (P=0.587), while those from chemotherapy initiation were 28.8, 28.7, and 29.0 months (P=0.496), in the respective groups. No significant differences in PFS or OS were observed among the three groups or between the GC-based and GCarbo regimens.
Conclusion: Avelumab maintenance showed comparable efficacy across the full-dose GC, reduced-dose GC, and GCarbo groups, highlighting the potential feasibility of personalized induction chemotherapy strategies. These findings may provide reassurance in clinical situations where full-dose cisplatin is not feasible due to patient frailty or renal dysfunction.
期刊介绍：
Research and Reports in Urology is an international, peer-reviewed, open access, online journal. Publishing original research, reports, editorials, reviews and commentaries on all aspects of adult and pediatric urology in the clinic and laboratory including the following topics: Pathology, pathophysiology of urological disease Investigation and treatment of urological disease Pharmacology of drugs used for the treatment of urological disease Although the main focus of the journal is to publish research and clinical results in humans; preclinical, animal and in vitro studies will be published where they will shed light on disease processes and potential new therapies. Issues of patient safety and quality of care will also be considered.
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