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Case Presentation: Progression of Metastatic Urothelial Cancer After Platinum-Based Chemotherapy Case Presentation
Patient Case:
A 75-year-old woman presents with a new diagnosis of metastatic urothelial cancer with enlarged pelvic & retroperitoneal lymph nodes and 2 small metastatic lesions in the left lung. She has an Eastern Cooperative Oncology Group (ECOG) performance status of 1, hypertension, hyperlipidemia. She denies hearing loss, neuropathy or autoimmune disease, and has normal organ function. Her globular filtration rate (GFR) is 60 ml/min and according to a 22C3 Agilent assay, has a PD-L1 combined positive score of 15.
After discussion, she received 6 cycles of a gemcitabine/cisplatin chemotherapy regimen. After 3 cycles, interim partial response is observed, and complete response on CT after 6 cycles. Following the chemotherapy, she started switch maintenance therapy of 800 mg avelumab every 2 weeks, as per the FDA label. This therapy was well-tolerated, with no significant adverse events. Follow-up included a computed tomographic chest abdomen pelvis (CT CAP) every 2 months and the patient maintained complete response for 10 months.
At 10 months, the CT revealed 3 new liver lesions (approximately 1.5 cm each). Her ECOG performance status is now 1. She denies any presence of skin rash, neuropathy, or diabetes mellitus, and is willing to come to the cancer center for therapy. Next-generation sequencing did not reveal the presence of FGFR2 or FGFR3 activating mutations or fusions.
