A 65-Year-Old Female With Urothelial Carcinoma - Episode 1

Case Review: 65-Year-Old Female With Urothelial Carcinoma

September 14, 2020
Robert Dreicer, MD, MS, MACP, FASCO

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

Initial presentation

  • A 65-year-old female presents with 2 weeks of intermittent gross hematuria
  • PMH: COPD, HTN
  • SH: 30-pack year smoking history

Clinical workup

  • Labs: Hb 10.2 g/dl, WBC 2.8 x 109/L, creatinine 1.3 mg/dL, creatinine clearance 68 ml/min; other WNL
  • TURBT large bladder mass, high grade muscle invasive urothelial cancer
  • CT scan of the abdomen and pelvis: large bladder mass, pelvic and para aortic adenopathy (largest 2.2 cm); CT Chest 3 sub cm nodules uncertain significance
  • Stage T3N2M1

Treatment

  • The patient received cisplatin + gemcitabine for 6 cycles; stable disease
  • Repeat imaging CT chest 2 of the sub cm lesions no longer appreciated
  • CT abd/pelvis decrease size in bladder mass, nodal findings mildly improved, no new disease
  • Avelumab 10 mg/kg IV q2W was started as maintenance therapy