Metastatic Giant Cell Bladder Variant of Urothelial Carcinoma: Description of a rare Case Report successfully treated by a 3 rd line chemotherapy with weekly paclitaxel

Background The giant cell variant of urothelial carcinoma (GCVUC) is an exceptionally rare and highly aggressive histologic subtype of bladder cancer, histologically characterized by pleomorphic multinucleated giant cells. Due to the lack of clinical data, its clinical behavior and optimal management remain poorly defined. Case presentation We report the case of a Caucasian, 52-year-old, no-smoker woman presenting with pelvic pain and hematuria and diagnosed with a locally advanced GCVUC. The patient initially received a neoadjuvant dose-dense MVAC chemotherapy followed by anterior pelvic exenteration with a pathological partial response. After metastatic recurrence, she underwent two lines of systemic therapy, including cisplatin/gemcitabine chemotherapy and immunotherapy. Considering the tumor progression, we started a 3 ^rd -line chemotherapy by weekly paclitaxel leading to a durable disease control. As the patient presented an isolated, pre-sacral lymph node progression, she underwent a stereotactic body radiotherapy (SBRT) that allowed a tumor complete response. At a follow up of more than 2 years, the patient is alive, in good clinical conditions and tumor-free. Conclusions This case highlights the importance of an individualized, multidisciplinary management strategy for GCVUC. The prolonged weekly paclitaxel may offer durable disease control in selected patients with a good tolerability. However, the addition of a targeted local treatment, such as SBRT, probably contributed to its efficacy. Further studies are warranted to establish evidence-based guidelines for this aggressive variant.