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Avelumab for maintenance treatment of locally advanced or metastatic urothelial cancer after platinum-based chemotherapy

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1 Recommendations

1.1 Avelumab is not recommended, within its marketing authorisation, for maintenance treatment of locally advanced or metastatic urothelial cancer that has not progressed after platinum-based chemotherapy in adults.

1.2 This recommendation is not intended to affect treatment with avelumab that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

Why the committee made these recommendations

There are no maintenance treatments routinely available for locally advanced or metastatic urothelial cancer that has responded to platinum-based chemotherapy. Clinical trial evidence shows that if people take avelumab it takes longer for their cancer to get worse, and they live longer than if they have best supportive care.

Avelumab does not meet NICE's criteria to be considered a life-extending treatment at the end of life. This is because it is uncertain how long people in the NHS who would be eligible for avelumab live for. The most likely cost-effectiveness estimates are much higher than what NICE normally considers an acceptable use of NHS resources. So avelumab is not recommended for routine use.

Avelumab is not suitable for use within the Cancer Drugs Fund because it is unlikely to be cost effective and further data collection is not an option. So avelumab is not recommended for use within the Cancer Drugs Fund.