Bladder cancer

First-line therapy of synchronous and metachronous metastatic UCa

Marc (73 years old)

Marc is a 73-year-old business analyst. He is diagnosed with metastatic bladder cancer during a workup for dysuria.

Assessment summary:

Former smoker (30 pack years)
Medical history: hypertension
CT chest, abdomen and pelvis: bone and lung metastases
Biopsy of lung lesion compatible with urothelial carcinoma (UCa)
ECOG PS: 1
No peripheral neuropathy, diabetes mellitus or autoimmune condition
Audiometric hearing loss grade 1
GFR: 90 ml/min
Left ventricular ejection fraction: 70%
PD-L1 expression: positive
FGFR2/3 status in tumour tissue specimen: wild type

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

Gemcitabine + carboplatin, then avelumab if no progression

Gemcitabine + cisplatin, then avelumab if no progression

Dose-dense MVAC, then avelumab if no progression

Pembrolizumab

Enfortumab vedotin + pembrolizumab

Nivolumab + gemcitabine + cisplatin