Karen (62 years old)

Karen is a 62-year-old dietitian. Yet, she is not very good at following her own professional advice, as she orders fast-food meals at least 5 nights a week.

She was diagnosed with MIBC cT2N0M0. She underwent neoadjuvant dose-dense MVAC followed by radical cystectomy. First follow-up scans were normal; 4 months after surgery, she presented with a lung metastasis.

Assessment summary:

• ECOG PS: 0
• Peripheral neuropathy grade I
• No hearing impairment
• GFR: 45 ml/min
• Tumour sample from cystectomy specimen stains strongly positive for PD-L1

She started systemic immunotherapy with very good response upon her first evaluation after 4 cycles.

One month later, she consulted for slow onset of cough and dyspnoea during active effort. Evaluation did not indicate an infection. CRP and procalcitonin were within normal range. CT of the chest ruled out pulmonary embolism, but confirmed persistent response to immune checkpoint inhibitors and identified diffuse ground glass opacities. The diagnosis of pneumonitis grade 2 was made.

Immunotherapy was stopped and the patient was put on oral steroids. After recovery, steroids were slowly tapered and 6 weeks later, she receives 10 mg prednisone/day.