Sonja (71 years old)

Sonja, a 71-year-old retired director of a candy factory, can no longer stand the sweet smell after having to endure it for so many years. Her grandchildren regret never receiving sweets when they visited her.

She underwent cystectomy for pT2N0M0 UCa of the bladder. Three years later, retroperitoneal lymph node metastases were discovered after which treatment with gemcitabine + cisplatin was started, followed by avelumab maintenance therapy. Despite having received avelumab maintenance therapy for 14 months, she now presents with new metastases.

Assessment summary:

• Former smoker (50 pack years)
• Medical history: moderate chronic obstructive pulmonary disease
• ECOG PS: 1
• CT scan reveals new and enlarged lesions in the retroperitoneal lymph nodes and new bone lesions
• GFR: 60 ml/min
• FGFR2/3 mutation status in diagnostic biopsy specimen: wild type