Robert Dreicer, MD, MS, MACP, FASCO: Let’s start today with a case. This is a 65-year-old woman who presents with 2 weeks of intermittent gross hematuria. She’s got a past medical history of airway disease and hypertension and a 30-pack-per-year smoking history. Her ECOG performance status is 1.
During your evaluation you find that she’s anemic, with a hemoglobin of 10.2 g/dL. Her creatinine is 1.3 mg/dL. The creatinine clearance is calculated as 68 mL/min. The rest of her chemistries were within normal limits.
She ultimately undergoes a transurethral resection for a bladder tumor. She has a high-grade muscle-invasive bladder cancer. Metastatic evaluation includes a CT scan of the chest, abdomen, and pelvis. In the chest there are a couple of subcentimeter nodules that are of uncertain significance. The CT scan of the abdomen and pelvis demonstrates both pelvic and periaortic adenopathy, the largest being around 2.2 cm.
The patient is advised to undergo therapy for metastatic disease with cisplatin and gemcitabine, and she receives a total of 6 cycles of therapy. The last couple of cycles get dropped. Upon reevaluation, her nodal disease appears to be grossly stable. A couple of the subcentimeter pulmonary nodules are now longer well visualized. The bladder mass is smaller. At this point in time, avelumab was recommended to be administered at 10 mg/kg every 2 weeks was and initiated as switch maintenance therapy.
Transcript edited for clarity.
Case: A 65-Year-Old Female With Urothelial Carcinoma