Arnold (75 years old)

Arnold, 75 years old, is a retired conductor of an orchestra. He still uses his old baton when music is playing, signalling hand gestures towards his guinea pigs. Not that they understand …

He was diagnosed with high-grade urothelial MIBC T2N0M0 and underwent neoadjuvant gemcitabine + cisplatin followed by radical chemoradiotherapy. Three months later, a CT scan revealed multiple retroperitoneal and intrathoracic lymph node metastases. He started pembrolizumab 7 months ago. After 12 weeks, a CT scan showed marginal progression in the lymph node metastases, but he continued with the immunotherapy. He presents again today.

Assessment summary:

• ECOG PS: 2
• Haemoglobin: 12.5 g/dl
• Peripheral neuropathy: grade 1 due to prior cisplatin
• Grade 2 immunotherapy-related hypothyroidism, treated with hormone replacement therapy
• No hearing impairment
• GFR: 45 ml/min
• CT scan reveals new and enlarging lymph node lesions
• FGFR2/3 mutation status in diagnostic biopsy specimen: wild type