4-weekly avelumab plus axitinib in patients with metastatic renal cell carcinoma

800 mg avelumab, given every 2 weeks, in combination with axitinib, is an approved first-line treatment option for patients with metastatic renal cell carcinoma (mRCC). Less frequent administration of avelumab would be preferable to patients and service providers but has not been previously explored.

We retrospectively analysed the clinical outcomes of patients from two academic centres who received 4-weekly avelumab plus axitinib between Oct 2019 and Oct 2023. Patients in cohort 1 (C1) were treated with 4-weekly avelumab from the start of therapy. Patients in cohort 2 (C2) initially received standard 2-weekly avelumab and were later switched to 4-weekly infusions. Overall response rate (ORR), progression-free survival (PFS), overall survival (OS) and toxicities leading to dose reductions or cessation were evaluated.

We identified 94 patients in total, 46 patients in C1 and 48 patients in C2. The majority (56%) of patients in both cohorts had IMDC favourable-risk disease. The ORR in C1 was 53% and the median PFS was 22.1 months. In C2, the median time to switch was 4.9 months (range 1.8-35.6) and median time on 4-weekly avelumab was 16.7 months (range 0.9-39.1). Toxicity was consistent with prior reports. Limitations include retrospective design.

These preliminary data support prospective evaluation of modified avelumab scheduling in patients with mRCC. Reducing treatment burden stands to improve patient quality of life and lower associated costs.