Skip survey header

Your BLADDR challenge

Thank You!

Your case challenge

View case
You answered: D
You answered: D
A) Gemcitabine + carboplatin
B) Gemcitabine + cisplatin
C) Dose dense MVAC
D) Systemic immune checkpoint inhibitor

What would Petros Grivas do?


This is a young man with very aggressive metastatic urothelial carcinoma of the bladder with liver & lung mets portending poor prognosis; comorbidities include diabetes mellitus with nephropathy (GFR 40 ml/min) and grade I neuropathy. Based on this low GFR it is difficult to use cisplatin-based chemotherapy, which would be ideal standard therapy.

Thus, options include clinical trial (preferably) or Gemcitabine/Carboplatin or pembrolizumab or atezolizumab. Tumor tissue has high PD-L1 status based on the companion diagnostic assay used with pembrolizumab. There is no available data yet comparing Gemcitabine/Carboplatin vs anti-PD-1/PD-L1 in tumors with high PD-L1 status, while randomized phase 3 trials are pending.

I would discuss with the patient the data by De Santis et al. [1] as well as those from Keynote 052 [2] and IMvigor210, cohort 1 trial [3], and other studies, and help him decide between options A and D.

I hope you can join us in Paris for BLADDR 2019 on 25-26 October to further discuss this and other interesting cases and clinical dilemmas.

1. De Santis M, et al. J Clin Oncol 2012;30:191-9.
2. Balar AV, et al. Lancet Oncol 2017;18:1483-92.
3. Balar AV, et al. Lancet 2017;389:67-76.

 
 


What would Petros Grivas do?


What would Petros Grivas do?


This is a young man with very aggressive metastatic urothelial carcinoma of the bladder with liver & lung mets portending poor prognosis; comorbidities include diabetes mellitus with nephropathy (GFR 40 ml/min) and grade I neuropathy. Based on this low GFR it is difficult to use cisplatin-based chemotherapy, which would be ideal standard therapy.

Thus, options include clinical trial (preferably) or Gemcitabine/Carboplatin or pembrolizumab or atezolizumab. Tumor tissue has high PD-L1 status based on the companion diagnostic assay used with pembrolizumab. There is no available data yet comparing Gemcitabine/Carboplatin vs anti-PD-1/PD-L1 in tumors with high PD-L1 status, while randomized phase 3 trials are pending.

I would discuss with the patient the data by De Santis et al. [1] as well as those from Keynote 052 [2] and IMvigor210, cohort 1 trial [3], and other studies, and help him decide between options A and D.

I hope you can join us in Paris for BLADDR 2019 on 25-26 October to further discuss this and other interesting cases and clinical dilemmas.

1. De Santis M, et al. J Clin Oncol 2012;30:191-9.
2. Balar AV, et al. Lancet Oncol 2017;18:1483-92.
3. Balar AV, et al. Lancet 2017;389:67-76.

 

Do you have an interesting case of your own?

Up to 3 case reports will be selected by the scientific committee for discussion in the official programme of BLADDR 2019.
 

Submit your case




Join us at BLADDR 2019 to get a full update on bladder cancer and discuss with faculty and peers how 2019 highlights will impact your daily practice.


Reserve your seat