Cases - BLADDR 2020 - Global Congress on Bladder Cancer

Case challenges

Key clinical data from major congresses translated into challenging cases.

 

Curious about the case challenges?
Compare yourself with your peers, and challenge the BLADDR faculty.

You can find the cases already sent hereunder.

Case 7 - Dave, a bladder cancer survivor on immunotherapy for more than 5 years. Share your opinion after watching the videos.

Dave is 73 years old and was diagnosed with bladder cancer more than 10 years ago. He underwent surgery, more surgery, chemotherapy and more chemotherapy, and then immunotherapy became an option.
Now, he is one of the longest living patients with bladder cancer on immunotherapy.

After watching the videos, could you spare another 3 minutes to answer some questions? Thank you!

 

What’s your opinion? Immunotherapy will be used in a much larger patient population with bladder cancer;
we’ve only seen the start so far.

Supported by an independent educational grant from Roche.

Case 6 - Guillaume, a 3 Michelin star chef, needs your help!

Guillaume, a 55-years-old master chef in a famous 3-star restaurant, never tastes the food he prepares “because it goes straight to his hips”, yet secretly stops by a highway hamburger restaurant on his way home for a big hamburger with French fries and a milkshake.
He is diagnosed with metastatic bladder cancer during a work up for dysuria.

Assessment summary:

  • Medical history: diabetes mellitus and diabetic nephropathy, otherwise healthy
  • CT chest, abdomen, pelvis: diffuse liver and lung metastases
  • ECOG PS: 0
  • Peripheral neuropathy: grade I due to diabetes mellitus
  • No hearing impairment, COPD or heart failure
  • Glomerular filtration rate (GFR): 40 ml/min due to diabetic nephropathy
  • PD-L1 expression: strongly positive, based on Agilent assay with CPS 50
What would be your next step in Guillaume’s case?
Case 5 - What would you do?

You edit a major uro-oncology journal and feel very proud that, last month, your journal published a European randomized trial on the treatment of locally advanced prostate cancer that seems to answer some of our most fundamental questions.
This morning, however, you have received an anonymous email from a physician informing you that the randomized trial had never taken place and the data is largely fabricated.

What would you do next?

A) “Assume the “whistleblower” is a disgruntled or jealous former partner of the first author who is set on revenge”
B) “Assume the “whistleblower” is correct and retract the article out of concern for the journal’s reputation”
C) “Challenge the first author with the accusations”
D) “Follow a process laid out by the Committee on Publishing Ethics”
E) “Call the police”

Case 4 - Fabienne, a gardener at Versailles, needs your help!

Fabienne is a 63-year-old gardener at the Palace of Versailles. As a firm believer in biological pesticides, she tries to remove all boxwood pillars manually. Certainly in the summer, she’s experiencing nervous breakdowns at the sight of brown boxwood bushes.

She was diagnosed 8 months ago with UCa metastatic to the lungs and was treated with gemcitabine + cisplatin.

First scans showed a reduced metastatic burden, however, 3 months ago, the CT scan revealed progressive disease according to RECIST v1.1 with new and enlarging lung lesions.

The patient started an immune checkpoint inhibitor and presents again today.

Assessment summary:

  • ECOG PS 1
  • CT scan showed further tumour progression
What would be your next step in Fabienne’s case?

 

Case 3 - Jean-Marc needs your help!

Jean-Marc, aged 56, is unemployed and still lives with his mother. He has a wide collection of fluorescent jackets and spends his time making cardboard signs for any strike that takes place in or around Paris.

He is recently diagnosed with muscle invasive bladder cancer:

  • Sonography: bladder mass, no hydronephrosis
  • Cystoscopy: right lateral wall bladder mass
  • Serum creatinine: 1.4 mg/dl; eGFR: 45 ml/min
  • TURBT: visually complete
    • High-grade UCa with involvement of the muscularis propria, minimum pT2
  • No comorbidities: liver, pulmonary and cardiovascular function normal
  • Imaging suggests cN0M0 disease

Jean-Marc prefers bladder sparing therapy.

Which treatment would you recommend for Jean-Marc?

 

Case 2 - Jean-Paul, a fashion designer, needs your help!

Jean-Paul is a fashion designer of haute-couture for cats and dogs. His collections never received the attention he feels they should have, except from some US celebrities with Chihuahuas. He is 60 years old and otherwise healthy.

Diagnostic work-up:

  • Cystoscopy: 1 papillary tumour at right bladder wall
  • TURBT:
    • Visually complete resection
    • pTaG3 high-grade
    • Muscle present in specimen, no LVI
Which option do you consider most appropriate for Jean-Paul?

 

Case 1 - Pauline, the guardian of the Mona Lisa, needs your help!

Pauline, aged 65, used to be the guardian of the Mona Lisa in The Louvre. The painting’s stare has turned Pauline a bit paranoia, thinking that someone is watching her all the time. Now, she’s anxious about her future since she’s recently diagnosed with muscle invasive bladder cancer. In contrast to her former colleagues at the museum, she never smoked.

Diagnostic work-up:

  • Sonography: bladder mass, no hydronephrosis
  • Cystoscopy: right lateral wall bladder mass
  • Serum creatinine: 0.9 mg/dl; eGFR: 65 ml/min
  • Diagnostic TURBT (incomplete resection, residual tumour): highgrade UCa with involvement of the muscularis propria, minimum pT2
  • Patient is cisplatin eligible and has no major comorbidities: liver, pulmonary and cardiovascular function normal
  • Imaging suggests cT2N0M0 disease

Following discussion with the multidisciplinary team, Pauline will undergo radical cystectomy with pelvic lymph node dissection. She has an appointment with a medical oncologist to discuss neoadjuvant therapy.

 

Which neoadjuvant treatment would you recommend for Pauline?
Case 7 - Dave, a bladder cancer survivor on immunotherapy for more than 5 years. Share your opinion after watching the videos.

Dave is 73 years old and was diagnosed with bladder cancer more than 10 years ago. He underwent surgery, more surgery, chemotherapy and more chemotherapy, and then immunotherapy became an option.
Now, he is one of the longest living patients with bladder cancer on immunotherapy.

After watching the videos, could you spare another 3 minutes to answer some questions? Thank you!

 

What’s your opinion? Immunotherapy will be used in a much larger patient population with bladder cancer;
we’ve only seen the start so far.

Supported by an independent educational grant from Roche.

Case 6 - Guillaume, a 3 Michelin star chef, needs your help!

Guillaume, a 55-years-old master chef in a famous 3-star restaurant, never tastes the food he prepares “because it goes straight to his hips”, yet secretly stops by a highway hamburger restaurant on his way home for a big hamburger with French fries and a milkshake.
He is diagnosed with metastatic bladder cancer during a work up for dysuria.

Assessment summary:

  • Medical history: diabetes mellitus and diabetic nephropathy, otherwise healthy
  • CT chest, abdomen, pelvis: diffuse liver and lung metastases
  • ECOG PS: 0
  • Peripheral neuropathy: grade I due to diabetes mellitus
  • No hearing impairment, COPD or heart failure
  • Glomerular filtration rate (GFR): 40 ml/min due to diabetic nephropathy
  • PD-L1 expression: strongly positive, based on Agilent assay with CPS 50
What would be your next step in Guillaume’s case?
Case 5 - What would you do?

You edit a major uro-oncology journal and feel very proud that, last month, your journal published a European randomized trial on the treatment of locally advanced prostate cancer that seems to answer some of our most fundamental questions.
This morning, however, you have received an anonymous email from a physician informing you that the randomized trial had never taken place and the data is largely fabricated.

What would you do next?
A) “Assume the “whistleblower” is a disgruntled or jealous former partner of the first author who is set on revenge”
B) “Assume the “whistleblower” is correct and retract the article out of concern for the journal’s reputation”
C) “Challenge the first author with the accusations”
D) “Follow a process laid out by the Committee on Publishing Ethics”
E) “Call the police”

 

Case 4 - Fabienne, a gardener at Versailles

Fabienne is a 63-year-old gardener at the Palace of Versailles. As a firm believer in biological pesticides, she tries to remove all boxwood pillars manually. Certainly in the summer, she’s experiencing nervous breakdowns at the sight of brown boxwood bushes.

She was diagnosed 8 months ago with UCa metastatic to the lungs and was treated with gemcitabine + cisplatin.

First scans showed a reduced metastatic burden, however, 3 months ago, the CT scan revealed progressive disease according to RECIST v1.1 with new and enlarging lung lesions.

The patient started an immune checkpoint inhibitor and presents again today.

Assessment summary:

  • ECOG PS 1
  • CT scan showed further tumour progression
What would be your next step in Fabienne’s case?
Case 3 - Jean-Marc

Jean-Marc, aged 56, is unemployed and still lives with his mother. He has a wide collection of fluorescent jackets and spends his time making cardboard signs for any strike that takes place in or around Paris.

He is recently diagnosed with muscle invasive bladder cancer:

  • Sonography: bladder mass, no hydronephrosis
  • Cystoscopy: right lateral wall bladder mass
  • Serum creatinine: 1.4 mg/dl; eGFR: 45 ml/min
  • TURBT: visually complete
    • High-grade UCa with involvement of the muscularis propria, minimum pT2
  • No comorbidities: liver, pulmonary and cardiovascular function normal
  • Imaging suggests cN0M0 disease

Jean-Marc prefers bladder sparing therapy.

 

Which treatment would you recommend for Jean-Marc?
Case 2 - Jean-Paul, a fashion designer

Jean-Paul is a fashion designer of haute-couture for cats and dogs. His collections never received the attention he feels they should have, except from some US celebrities with Chihuahuas. He is 60 years old and otherwise healthy.

Diagnostic work-up:

  • Cystoscopy: 1 papillary tumour at right bladder wall
  • TURBT:
    • Visually complete resection
    • pTaG3 high-grade
    • Muscle present in specimen, no LVI
Which option do you consider most appropriate for Jean-Paul?
Case 1 - Pauline, the guardian of the Mona Lisa

Pauline, aged 65, used to be the guardian of the Mona Lisa in The Louvre. The painting’s stare has turned Pauline a bit paranoia, thinking that someone is watching her all the time. Now, she’s anxious about her future since she’s recently diagnosed with muscle invasive bladder cancer. In contrast to her former colleagues at the museum, she never smoked.

Diagnostic work-up:

  • Sonography: bladder mass, no hydronephrosis
  • Cystoscopy: right lateral wall bladder mass
  • Serum creatinine: 0.9 mg/dl; eGFR: 65 ml/min
  • Diagnostic TURBT (incomplete resection, residual tumour): highgrade UCa with involvement of the muscularis propria, minimum pT2
  • Patient is cisplatin eligible and has no major comorbidities: liver, pulmonary and cardiovascular function normal
  • Imaging suggests cT2N0M0 disease

Following discussion with the multidisciplinary team, Pauline will undergo radical cystectomy with pelvic lymph node dissection. She has an appointment with a medical oncologist to discuss neoadjuvant therapy.

 

Which neoadjuvant treatment would you recommend for Pauline?

Join the case discussion

At the congress in Paris, we will discuss several cases. Challenge the expert panel during these patient case sessions.

Mirrors of Medicine

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ISSECAM

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e-HIMS

Endorsed by ESTRO