Case 1: Kateryna (80 years old)

Kateryna is an 80-year-old retired elementary school teacher. She enjoys having morning tea on her terrace, hoping to meet some of her former students.

She was diagnosed with muscle-invasive bladder cancer (MIBC) cT2N0M0 and underwent radical cystectomy (RC). The pathological review of the RC specimen indicated pT2 pN0 (0/10) R0, PD-L1 positive. First follow-up scans were normal; 4 months after surgery, she presented with a lung metastasis.

Assessment summary:

• Medical history: mild hypertension
• ECOG PS: 2
• Peripheral neuropathy grade 1
• No hearing impairment
• GFR: 45 ml/min
• FGFR2/3 mutation status in diagnostic biopsy specimen: wild type

She started pembrolizumab with very good response after 4 cycles. One month later, she experienced cough and dyspnoea during active effort, but evaluation did not indicate any infection. C-reactive protein and procalcitonin were within normal range. CT of the chest ruled out pulmonary embolism and confirmed persistent tumour but identified diffuse ground glass opacities. She was diagnosed with grade 2 pneumonitis.