Maintenance avelumab in a patient with metastatic urothelial carcinoma on hemodialysis: A case report

Abstract

Standard of care treatment for metastatic urothelial cancer involves the use of platinum-based chemotherapy followed by maintenance immune checkpoint inhibitor (ICI) with a PD-L1 inhibitor avelumab based on the results of the JAVELIN Bladder 100 trial. However, little or no data exists regarding the use of chemotherapy followed by avelumab maintenance in patients with end stage renal disease (ESRD) on hemodialysis (HD), since such patients were typically excluded in clinical trials. We report a case of a patient with urothelial cancer who developed metastatic disease and achieved durable radiographic complete response after treatment with gemcitabine and carboplatin chemotherapy followed by avelumab maintenance with clearance of circulating tumor DNA (ctDNA). This case highlights the importance of avoiding denying patients with concomitant ESRD on HD potentially life-prolonging therapy and exploring feasibility and safety of ICI in patients with ESRD on HD. In addition, current existing literature on ICI use in metastatic urothelial patients with ESRD are reviewed herein.

Keywords

• Dialysis
• Chemotherapy
• Metastatic urothelial cancer
• Avelumab
• Case report
• Maintenance therapy