Bladder cancer
UPDATED --- First-line therapy of synchronous and metachronous metastatic UCa

Elio (74 years old)

Elio is a 74-year-old former accountant who now enjoys solving complex crossword puzzles.

He completed 4 cycles of neoadjuvant gemcitabine + cisplatin before undergoing RC and pelvic lymph node dissection for MIBC.

Post-operative outcomes:

  • Pathological review: ypT2bN2 (3/10)
  • Imaging: suggestive for cM0

He started adjuvant nivolumab therapy 5 months ago.

Assessment summary today (9 months after last dose of neoadjuvant chemotherapy):

  • No relevant medical history, except for elevated creatinine after chemotherapy
  • ECOG PS: 1
  • CT scan of chest, abdomen and pelvis: intrathoracic lymph node metastases, biopsy compatible with UCa
  • No peripheral neuropathy
  • No audiometric hearing loss
  • GFR: 48 ml/min
  • FGFR2/3 alteration status in metastatic biopsy specimen: wild type

Which of the following options would you choose for this patient?