Peggy (75 years old)

Peggy, 75 years old, used to be a history teacher. Since her retirement, she has kept her passion alive by helping to organise the historical reenactment of the Battle of Waterloo.

Unfortunately, she was diagnosed with high-grade urothelial MIBC T2N0M0 and underwent neoadjuvant gemcitabine + cisplatin followed by radical chemoradiotherapy. 3 months later, a CT scan revealed multiple retroperitoneal lymph nodes and lung metastases. She started pembrolizumab 7 months ago. 12 weeks after the start of pembrolizumab, a CT scan showed marginal progression in the lymph node metastases, but she continued with the immunotherapy. She presents again today.

Assessment summary:

• ECOG PS: 2
• Haemoglobin: 11.5 g/dl
• Peripheral neuropathy: grade 1 due to prior cisplatin
• Grade 2 immunotherapy-related hypothyroidism, treated with hormone replacement therapy
• No hearing impairment
• GFR: 45 ml/min
• CT scan reveals new and enlarging lymph node lesions
• FGFR2/3 alteration status in metastatic biopsy specimen: activating FGFR3 mutation