Rosa (75 years old)

Rosa, a 75-year-old woman, owned a small bookstore in the town where she grew up. She was heartbroken when 10 years ago she had to sell it. She has an aversion to e-readers, as she loves the smell of books.

She was diagnosed with MIBC cT2N1M0 and underwent neoadjuvant gemcitabine + cisplatin followed by radical chemoradiotherapy. A second transurethral resection of bladder tumour (TURBT) and random bladder biopsies did not show any residual tumour after chemoradiotherapy. Imaging was suggestive for cT0N0M0. Chemotherapy was well tolerated, with grade 1 neutropenia and grade 1 anaemia.

She presents with lung metastases 15 months after completing neoadjuvant chemotherapy.

Assessment summary:

• Former smoker (50 pack years)
• Medical history: chronic obstructive pulmonary disease, hypertension
• ECOG PS: 1
• CT scan reveals lung metastases, biopsy compatible with UCa
• Peripheral neuropathy grade 1
• Audiometric hearing loss grade 1
• GFR: 45 ml/min
• PD-L1 expression: negative
• FGFR2/3 mutation status in diagnostic biopsy specimen: wild type