Case 2026: Henk (expert opinion by P. Grivas)

Henk, currently 72 years old, used to work for the ‘Anne Frank House’ and remains closely connected to the museum’s mission. He takes quiet satisfaction in seeing how many people from around the world continue to visit the site each year, ensuring that history is not forgotten.

He was initially diagnosed with MIBC (cT3N0M0) and received 4 cycles of neoadjuvant gemcitabine + cisplatin (GC) + durvalumab followed by RC + PLND without significant complications. Pathological review of the RC specimen indicated ypT2N0 (0/10) R0. He received adjuvant durvalumab for 8 cycles. First follow-up scans showed no evidence of disease, however, 12 months after completion of durvalumab, he presents with retroperitoneal lymph nodes (up to 3 cm short axes) and multiple lung metastases on CT.

Treatment with enfortumab vedotin + pembrolizumab (EV+P) was started. After 17 cycles of treatment, he has progressive disease again. 

Current situation:

• Medical history:
  • Former smoker (40 pack years)
  • Hypertension, peripheral artery disease (PAD)
• ECOG PS: 1
• Peripheral neuropathy: grade 1
• Audiometric hearing loss: grade 2
• GFR: 45 ml/min
• CT reveals new and enlarging retroperitoneal lymph node metastases, biopsy compatible with conventional urothelial carcinoma histology