Case 2023: Pablo (expert opinion by M. De Santis)

Pablo, a 68-year-old vintager, spent his whole life on the vineyard harvesting Moscatel grapes and sun-drying them until they become the traditional las Pasas de Malaga. Now that he is retired, he prefers drinking the grapes as the sweet fortified Moscatel and Pedro Ximénez wines.

He was diagnosed with UCa of the bladder metastatic to the pelvic lymph nodes and lungs and was treated with first-line gemcitabine + cisplatin. At the end of chemotherapy, the CT scan revealed new and enlarging lung lesions. Treatment with pembrolizumab was started, but 6 months later he shows again progressive disease.

Assessment summary:

• No relevant medical history
• ECOG PS: 1; increasing breathlessness and cough
• CT scan of chest, abdomen and pelvis: new and enlarged lesions in the lungs
• FGFR2/3 mutation status in diagnostic biopsy specimen: wild type

The patient started enfortumab vedotin (EV) with a very good response. 5 months after the start of treatment, the patient develops grade 2 peripheral neuropathy (PNP).

Pharmacological intervention is being started to manage the neuropathic pain.