Bladder cancer
Initial treatment of MIBC

Keith (75 years old)

Keith, 75 years old, doesn’t like sweet pastries. He never dared to tell his wife who is a retired pastry sous chef. Now he is forced to taste her baking every weekend …

He underwent cystoscopy for painless haematuria, which revealed a papillary tumour.

Assessment summary:

  • No relevant medical history
  • Pathological review maximal TURBT:
    • Minimal pT2 UCa
    • Unifocal, no concomitant CIS
  • Imaging: suggestive for cT2 cN2 cM0
  • Ultrasound: no hydronephrosis
  • eGFR: 70 ml/min
  • No peripheral neuropathy
  • No hearing impairment
  • ECOG PS: 1
  • Cardiac ejection fraction: 70%

Which of the following treatment options would you choose as a first step for this patient?