Avelumab is in clinical development for gastric or gastro-oesophageal cancer. Gastric cancer is cancer that starts anywhere inside the stomach or the stomach wall. Advanced gastric cancer can be locally advanced (has spread into the tissues around the stomach) or metastatic (has spread to at least one other part of the body such as the liver). Advanced or metastatic cancers have poor prognosis and often have no cure (surgically), but treatment may control further growth of the disease, relieve symptoms and give the patient a good quality of life. Treatment strategy often involve an induction phase to preserve patient quality of life and a maintenance phase to prolong treatment benefit.
Avelumab is a human monoclonal antibody designed to recognise and attach to a protein called ‘programmed death-ligand-1’ (PD-L1). PD-L1 is a protein produced by several cancers and prevents the activation of T cells, which are part of the body’s immune (defence) system. Avelumab blocks PD-L1 which prevents the cancer cells from switching off the T cells, increasing the ability of the T cells to kill the cancer cells. Early results have shown that avelumab was well tolerated and showed promising clinical activity with good response rate when given as first line maintenance in patients with advanced or metastatic gastric or gastro-oesophageal junction cancer.
Nivolumab in combination with ipilimumab is in clinical development for PD-L1 positive patients with previously untreated unresectable or metastatic urothelial cancer regardless of cisplatin eligibility. Urothelial cancer, a subset of bladder cancer, occurs on the lining of the renal pelvis, ureter, bladder and urethra, and other parts of the urinary system. In some cases,the tumour spreads into the surrounding muscles or other parts of the body which means that it cannot be cured by surgery. Metastatic urothelial cancer occurs when the cancer has spread to other parts of the body, such as the liver or bones. The symptom of urothelial cancer is blood in the urine, but symptoms may only appear once the cancer grows larger or into the deeper layers of the bladder wall for both men and women. Other symptoms may include increased frequency/urgency/pain of urine passing, weight loss, back/lower tummy/bone pain, fatigue and illness.