Case 2: Cisplatin-Ineligible Metastatic Bladder Cancer

EXPERT PERSPECTIVE VIRTUAL TUMOR BOARD

Arlene O. Siefker-Radtke, MD:I’d like to move on to case number 2, which is a 68-year-old Caucasian man who was referred to urology after an evaluation for gross hematuria. As anticipated in most bladder cancer patients, he has a past history of hypertension and COPD [chronic obstructive pulmonary disease] from smoking with a 30-year smoking history. He has a cystoscopy from one of D. Brown’s colleagues showing a nodular 8 cm mass at the left urethral orifice. And on transurethral resection, has a high-grade urothelial carcinoma invading into the muscularis propria. His PD-L1 [programmed death-ligand 1] score by CPS [combined positive score] was greater than 10.

However, on imaging, we had some unfortunate news where he had both enlarged pelvic lymph nodes and lung metastases. A bone scan was negative, but his creatinine clearance calculated by Cockcroft-Gault was about 42 mL/minute. So he’s now been diagnosed with a metastatic bladder cancer with borderline or poor kidney function.

Transcript edited for clarity.