Bladder cancer
NEW --- Molecular diagnostics in the era of targeted therapies for mUCa

Karim (65 years old)

Karim, a 65 years old freelance photographer, loves embarking on new adventures around the world to capture breathtaking landscapes and vibrant cultures. He initially presented with UCa of the bladder with bone and lymph node metastases and was treated with 6 cycles of gemcitabine + cisplatin. After progression with new bone metastases, he received pembrolizumab, but the treatment was stopped after 10 cycles due to grade 4 immune-related colitis.

Assessment summary:

  • ECOG PS: 1
  • Peripheral neuropathy: grade 1 due to prior cisplatin
  • No hearing impairment
  • GFR: 70 ml/min
  • Medical history: mild hypertension, hyperthyroidism
  • Lymph node biopsy testing results: FGFR3 mutation R248C

After complete recovery from the immune-related colitis, the patient shows disease progression.

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