Nelson (73 years old)

Nelson is 73 years old and lives near the seaside. During summer, he enjoys swimming together with his grandson.

He was diagnosed with MIBC cT2N0M0 and underwent neoadjuvant gemcitabine + cisplatin followed by RC. The pathological review of the RC specimen indicated ypT2 ypN0 (0/10) R0, PD-L1 positive. First follow-up scans were normal; but 4 months after surgery, he presented with retroperitoneal lymph node metastases.

Assessment summary:

• Medical history: mild hypertension
• ECOG PS: 1
• Peripheral neuropathy grade 1
• FGFR2/3 mutation status in diagnostic biopsy specimen: activating FGFR3 mutation

He started pembrolizumab with very good response after 4 cycles. 1 month later, he was hospitalised with severe shortness of breath and hypoxia, but lab tests did not indicate any infection. CT scan of the chest, abdomen and pelvis ruled out pulmonary embolism and confirmed persistent response to immune checkpoint inhibitors. Ground glass opacities were observed in most of the lung lobes, indicating grade 3 pneumonitis.

Immunotherapy was discontinued and the patient was put on intravenous steroids. After recovery, steroids were tapered over 4 weeks later to 10 mg prednisone/day.