Bladder cancer
First-line therapy of synchronous and metachronous metastatic UCa

Rodrigo (67 years old)

Rodrigo is a 67-year-old, retired video game programmer. He was diagnosed with MIBC (cT3bN0M0) and received 4 cycles of neoadjuvant gemcitabine + cisplatin (GC) + durvalumab followed by RC + PLND without significant complications. Pathological review of the RC specimen indicated ypT2N0 (0/10) R0. He received adjuvant durvalumab for 8 cycles. 

First follow-up scans showed no evidence of disease, however, 9 months after completion of durvalumab, he presents with retroperitoneal lymph nodes (up to 3 cm short axes) and multiple lung metastases on CT.

Current situation:

  • Medical history: hypertension, chronic kidney disease
  • ECOG PS: 1
  • GFR: 45 ml/min
  • Peripheral neuropathy: grade 1
  • Audiometric hearing loss: grade 2
  • Biopsy of lung metastasis:
    • Pure UCa
    • Activating FGFR3 mutation
       

Which of the following options would you choose for this patient?