Samanta (80 years old)

Samanta is an 80-year-old food critic. Being renowned for her sharp reviews, every chef in her village shakes with fear when they see her entering their restaurants.

She was diagnosed with MIBC cT2N0M0 and underwent RC. The pathological review of the RC specimen indicated pT2 pN0 (0/10) R0, PD-L1 positive. First follow-up scans were normal; 4 months after surgery, she presented with a lung metastasis.

Assessment summary:

• Medical history: mild hypertension
• ECOG PS: 2
• Peripheral neuropathy grade 1
• No hearing impairment
• GFR: 45 ml/min
• FGFR2/3 mutation status in diagnostic biopsy specimen: wild type

She started pembrolizumab with very good response after 4 cycles. One month later, she experienced cough and dyspnoea during active effort, but evaluation did not indicate any infection. C-reactive protein and procalcitonin were within normal range. CT of the chest ruled out pulmonary embolism and confirmed persistent tumour but identified diffuse ground glass opacities. She was diagnosed with grade 2 pneumonitis.

Immunotherapy was discontinued and the patient was put on oral steroids. After recovery, steroids were tapered over 4 weeks to 10 mg prednisone/day.