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BLADDR2019 - Case 01

Your case challenge (apply data presented at ASCO GU)

Pauline, aged 65, used to be the guardian of the Mona Lisa in The Louvre. The painting’s stare has turned Pauline a bit paranoia, thinking that someone is watching her all the time. Now, she’s anxious about her future since she’s recently diagnosed with muscle invasive bladder cancer. In contrast to her former colleagues at the museum, she never smoked.

Diagnostic work-up:

  • Sonography: bladder mass, no hydronephrosis
  • Cystoscopy: right lateral wall bladder mass
  • Serum creatinine: 0.9 mg/dl; eGFR: 65 ml/min
  • Diagnostic TURBT (incomplete resection, residual tumour): highgrade UCa with involvement of the muscularis propria, minimum pT2
  • Patient is cisplatin eligible and has no major comorbidities: liver, pulmonary and cardiovascular function normal
  • Imaging suggests cT2N0M0 disease

Following discussion with the multidisciplinary team, Pauline will undergo radical cystectomy with pelvic lymph node dissection. She has an appointment with a medical oncologist to discuss neoadjuvant therapy.

Which neoadjuvant treatment would you recommend for this patient?