John (83 years old)

John, 83 years old, was a professional sailor and participated in many regattas. Today he does not compete anymore, but still enjoys relaxing on his small boat.

He was diagnosed with MIBC cT2N0M0 and underwent RC without receiving neoadjuvant chemotherapy because he was cisplatin-ineligible. The pathological review of the RC specimen indicated pT2b pN2 (3/10) R0, PD-L1-positive. He received adjuvant nivolumab. First follow‑up scans were normal, however, 15 months after surgery, he presents intrathoracic lymph node metastases.

Assessment summary:

• Medical history: hypertension, chronic kidney disease
• ECOG PS: 1
• CT scan reveals intrathoracic lymph node metastases, biopsy compatible with UCa
• Peripheral neuropathy grade 1
• Audiometric hearing loss grade 2
• GFR: 45 ml/min
• Activating FGFR3 mutation in diagnostic biopsy specimen