Sinead (62 years old)

Sinead is a 62-year-old former dog hairdresser. She practically invented the perm for poodles!

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 RC specimen stains strongly positive for PD-L1

She started pembrolizumab 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. C-reactive protein (CRP) and procalcitonin were within normal range. CT of the chest ruled out pulmonary embolism and confirmed persistent tumour response to the immune checkpoint inhibitor, but identified diffuse ground glass opacities. The diagnosis of pneumonitis grade 2 was made.