(UroToday.com) Cisplatin chemotherapy is the standard of care for medically fit patients in advanced urothelial carcinoma. Unfortunately, up to 50% of these patients are medically ineligible for cisplatin due to low-performance status, renal dysfunction, or other medical comorbidities.  Immune checkpoint blockade is a first-line therapeutic option in either platinum ineligible patients or carboplatin eligible patients whose tumors also express PD-L1. Patients who are ineligible for cisplatin and progress on immune checkpoint blockade have limited treatment options, and many efforts are underway to expand the therapeutic armamentarium for this disease context.