Macy (71 years old)

Macy, 71 years old and a retired paediatrician, is today the proud full-time nanny of her 5 grandchildren.

She was diagnosed with MIBC cT2N0M0 and underwent neoadjuvant gemcitabine + cisplatin followed by RC. The pathological review of the RC specimen indicated pT2b pN0 (0/10) R0. She did not receive adjuvant therapy. First follow-up scans were normal, however, 8 months after surgery, she presents with retroperitoneal lymph node metastases and started treatment with pembrolizumab. First follow-up scans were normal, however, 9 months after the start of pembrolizumab, she has again progressive disease.

Assessment summary:

• Medical history: grade 2 retinal detachment
• ECOG PS: 2
• CT scan reveals new and enlarging retroperitoneal lymph node metastases, biopsy compatible with UCa
• Peripheral neuropathy: grade 1
• Audiometric hearing loss: grade 2
• GFR: 45 ml/min
• FGFR2/3 alteration status in metastatic biopsy specimen: activating FGFR3 alteration