Andrei CEOBANU1,2, Ioana-Roxana CÂRLAN1, Radu Sebastian GAVRIL1,2, Vasile SÂRBU3,4, Florin MITU1,2,3,4
Abstract. Introduction. Metastatic urothelial carcinoma (mUC) is an aggressive malignancy with poor prognosis. While platinum-based chemotherapy remains an important option in the first line setting, many older patients present with significant comorbidities precluding cisplatin use, necessitating alternative regimens or immune checkpoint inhibitors (ICIs). Case presentation. We present a 71-year-old female with severe cardiovascular and renal comorbidities—including NYHA class II heart failure, atrial fibrillation, grade III hypertension, and chronic kidney disease—who presented with severe weight loss and gross hematuria. Diagnostics revealed cT4aN2M1a (Stage IV) high-grade infiltrative urothelial carcinoma. To manage persistent bleeding, palliative hemostatic radiotherapy (21 Gy) was first administered. Deemed cisplatin-ineligible due to impaired renal function (GFR 35 mL/min), an ECOG performance status of 2, and advanced heart failure, she was successfully treated with a tailored six cycles of first-line carboplatin and gemcitabine (CG), demonstrating good clinical tolerance. Subsequently, 6 months after the end of CG therapy, progression in the regional and distant adenopathy was noted, and second-line atezolizumab was initiated. Remarkably, despite her extensive baseline cardiovascular disease, she tolerated the ICI well, achieving a progression-free survival (PFS) exceeding 5 years. Conclusions. Although this patient achieved an outstanding clinical outcome with no immune-related adverse events, a strong working knowledge of atezolizumab’s cardiovascular safety profile is highly warranted. A short literature review documents the potential for rare but severe cardiovascular complications associated with ICIs. Consequently, vigilant cardio-oncology monitoring remains critical, especially during long-term ICI maintenance in patients with pre-existing severe cardiac conditions.
Keywords: metastatic urothelial carcinoma, immune checkpoint inhibitors, cardio-oncology, long-term survival.
DOI 10.56082/annalsarscimed.2026.1.33
1 Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, Iasi, Romania
2 Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, Iasi, Romania; e-mail: rgavril87@yahoo.com
3 Academy of Romanian Scientists, Iasi, Romania
4 Academy of Medical Sciences, Bucharest, Romania
PUBLISHED in Annals of the Academy of Romanian Scientists Series of Medicine, Volume 7, Issue 1