Bladder cancer
First-line therapy of synchronous and metachronous metastatic UCa

Jacob (73 years old)

Jacob, 73 years old, is the former owner of a popular bar at the seaside. He now enjoys a quiet life with his wife in their beach house.

He is diagnosed with metastatic bladder cancer during a workup for dysuria.

Assessment summary:

  • Former smoker (30 pack years)
  • Medical history: hypertension
  • CT scan of chest, abdomen and pelvis: bone and lung metastases
  • Biopsy compatible with UCa
  • ECOG PS: 1
  • No peripheral neuropathy
  • Audiometric hearing loss grade 1
  • Glomerular filtration rate (GFR): 90 ml/min
  • Cardiac ejection fraction: 70%
  • PD-L1 expression: strongly positive

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