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Top Line: Immune checkpoint inhibitors are elbowing their way into first-line therapy for advanced urothelial carcinoma.
The Study: We already know that adding avelumab maintenance (i.e., sequential) therapy to first-line platinum chemotherapy improved overall survival in JAVELIN Bladder 100. So in the three-arm IVvigor130 trial, over 1200 patients with advanced urothelial carcinoma were randomized to platinum-based chemo (cis or carbo + gemcitabine), chemo and concurrent atezolizumab, or atezolizumab monotherapy. The primary comparison arms were chemo versus chemo-atezo with a secondary comparison of chemo versus atezo alone. Overall survival (OS) and progression-free survival (PFS) were co-primary endpoints, and here we have final reporting of PFS and interim reporting of OS. Adding atezo to chemo significantly prolonged median PFS from 6 → 8 months. Median OS was prolonger 13 → 16 months, but this did not reach significance for the interim analysis. There were no differences in treatment outcomes when atezo monotherapy was compared to chemotherapy alone.
TBL: Adding concurrent atezolizumab to first-line platinum-based chemotherapy improves at least progression-free survival for patients with advanced urothelial carcinoma. | Galsky, Lancet 2020