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BLADDR 2020 case 2 - Grivas

Your case challenge

Agnieszka is a 48-year-old chemistry teacher. She’s heavily inspired by Marie Curie, née Skłodowskaja, winner of 2 Nobel Prizes, and secretly hopes she too might win a Nobel Prize, if only she could find the secret formula for turning lead into gold… 

She was diagnosed with metastatic urothelial bladder cancer during investigation of dysuria. Germline testing was negative for mutations. Somatic tumour testing did not show FGFR2 or FGFR3 alterations.
Assessment summary:

  • Medical history: no relevant past medical history
  • CT scan of chest, abdomen and pelvis: diffuse liver and lung metastases
  • ECOG PS: 1
  • Glomerular filtration rate: 90 ml/min
  • PDL1 expression: combined positive score (CPS) 30


A month ago, she received the last of 4 cycles gemcitabine + cisplatin. She has a partial response but has developed significant neuropathy and fatigue and does not want more chemotherapy.

What would you suggest to Agnieszka?