Denis (77 years old)

77-year-old Denis worked as a judge for his whole life. Now he spends his days writing a memoir of his most memorable cases.

He is diagnosed with metastatic UCa of bladder.

Assessment summary:

• Medical history:
  • Type 2 diabetes mellitus, previously poorly controlled (HbA1c 9.5%), currently improved under endocrinology follow-up
  • Hypertension
• CT scan of chest, abdomen and pelvis: diffuse liver and bone metastases, biopsy compatible with UCa
• ECOG PS: 1
• No peripheral neuropathy
• No hearing impairment
• GFR: 40 ml/min

The patient completed 4 cycles of gemcitabine + carboplatin and achieved stable disease. Maintenance with avelumab was initiated. After 5 cycles of avelumab, imaging demonstrated a partial response, with marked regression of liver metastases and 4 residual bone lesions remaining.

At this time, he developed watery diarrhoea, abdominal cramping, urgency, and abdominal pain. Stool evaluation excluded an infectious cause. A diagnosis of grade 2 immune-mediated colitis was made.