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  1. Wood, Laura S. MSN, RN, OCN(R)
  2. Conway, Dawn BSN, RN, OCN(R)
  3. Lapuente, Maria RN
  4. Salvador, George RGN
  5. Fernandez Gomez, Sheila RN, CNS
  6. Carroll Bullock, Andrea BSN, ISMPP, CMPP
  7. Devgan, Geeta PhD
  8. Burns, Kathleen D. MSN, RN, ACAGNP-BC, OCN(R)


Immune checkpoint inhibitors, such as programmed cell death ligand 1 inhibitors pembrolizumab, nivolumab, atezolizumab, and avelumab, are used to treat patients with advanced urothelial carcinoma (UC). Based on data from the phase 3 JAVELIN Bladder 100 trial, avelumab first-line (1L) maintenance is now considered the standard-of-care treatment for patients with locally advanced or metastatic UC who responded or experienced disease stabilization after 1L platinum-containing chemotherapy, and it is the only category 1 preferred checkpoint inhibitor maintenance option in the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology for patients with cisplatin-eligible and cisplatin-ineligible locally advanced or metastatic UC. This article reviews key considerations related to avelumab 1L maintenance therapy that infusion nurses should be familiar with, including dosing, administration, and immune-related adverse event recognition and management, to ensure safe and appropriate use of this important and impactful therapy.