(UroToday.com) Curative intent therapy in muscle invasive bladder cancer (MIBC) can be accomplished by either cisplatin-based chemotherapy followed by radical cystectomy, or trimodality bladder preservation therapy via maximal transurethral resection of the bladder tumor (TURBT) followed by chemoradiation. No randomized trials have compared these two options, though propensity risk-matched cohort analyses suggest similar outcomes. Furthermore, the optimal chemoradiation regimen has not been defined, and hypofractionated radiotherapy combined with gemcitabine has shown promising efficacy and safety. Given there is potential synergy between immune checkpoint blockade and chemotherapy, Dr. Balar and colleagues designed a multicenter phase 2 clinical trial to assess the safety and efficacy of pembrolizumab added to standard trimodality bladder preservation therapy using gemcitabine and hypofractionated radiotherapy. The schema for this trial is shown below.