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MRx0518 + avelumab is an investigational **combination regimen** of the live biotherapeutic product MRx0518 and the immune checkpoint inhibitor avelumab, studied for maintenance therapy in metastatic solid tumors, notably unresectable locally advanced or metastatic urothelial carcinoma after response or stable disease following platinum-based chemotherapy. MRx0518 is an oral, single-strain, live biotherapeutic bacterium (*Enterococcus gallinarum*), selected for its immunostimulatory properties, including enhancement of anti-tumor immune responses (increased CD4+, CD8+ T cells and NK cells, reduced Tregs), and modulation of the tumor microenvironment. Avelumab is an intravenous monoclonal antibody checkpoint inhibitor targeting PD-L1, disrupting its interaction with PD-1 and restoring anti-tumor T cell activity. The combination aims to synergistically boost anti-cancer immune responses: MRx0518 potentially enhances immune infiltration and activation, augmenting the clinical benefit of avelumab in the maintenance setting. Clinical trials are assessing the safety and efficacy of this combination in urothelial carcinoma and other tumor types[1][3][5].
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