Fidel (72 years old)

Fidel, a 72-year-old bus driver, is looking forward to participating in the upcoming national classics car exhibition. He is diagnosed with metastatic bladder cancer during a workup for dysuria.

Assessment summary:

• Former smoker (30 pack years)
• Medical history: hypertension
• CT scan of chest, abdomen and pelvis: bone and lung metastases, biopsy compatible with UCa
• ECOG PS: 1
• No peripheral neuropathy, diabetes mellitus or autoimmune condition
• Audiometric hearing loss: grade 1
• GFR: 90 ml/min
• Cardiac ejection fraction: 60%
• PD-L1 expression: positive
• FGFR2/3 alteration status in metastatic biopsy specimen: wild type

The patient started enfortumab vedotin + pembrolizumab.

• 2 weeks after the first administration: he developed grade 1 maculopapular rash at the site of injection, which self-resolved within a week. No other major side effects were reported.
• Follow-up at 6 months indicated partial response. The patient has now completed 12 cycles of therapy and imaging shows complete remission of the lung metastases, and only 1 small bone lesion remaining.