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Outcomes for patients with advanced or metastatic urothelial carcinoma (UC) remain poor. Targeting the programmed death ligand-1 (PD-(L)1) immune checkpoint pathway has emerged as a useful target in patients with UC. Avelumab is a PD-L1 inhibitor, resulting in restoration of a cytotoxic, antitumor T cell response. Results from the JAVELIN bladder 100 trial has resulted in a new standard of care of platinum-based chemotherapy sequenced by maintenance avelumab in advanced or metastatic UC. This review covers the clinical evidence for avelumab in UC. This includes the maintenance approach with avelumab, which has become the standard of care, following platinum-based chemotherapy. Immune checkpoint inhibitor treatment in metastatic UC holds much promise, but has not been optimized. First-line maintenance avelumab is an attractive option for these patients. Future research will significantly change the landscape of treatment in the near future.

Avelumab in locally advanced or metastatic urothelial carcinoma