How do you treat metastatic bladder cancer with extensive squamous differentiation in a cisplatin-ineligible patient?

The impetus for the question is presumably the impact of squamous differentiation on what has become the standard for metastatic urothelial cancer, namely enfortumab vedotin combined with pembrolizumab. Trials leading to the approval in the metastatic space as well as the perioperative space all req...

First, ask for pathology re-review to quantify the percentage of squamous differentiation vs. urothelial component. If the squamous component is <50%, EV + pembrolizumab with close monitoring remains appropriate (Salous et al., ASCO 2026).

The next most important action is comprehensive biomarker tes...