How would you treat a patient who has progression of nodal metastases while receiving neoadjuvant gemcitabine/cisplatin?

This tumor biology appears resistant to cisplatin, therefore would consider alternative systemic therapy, e.g. clinical trial or immune checkpoint inhibitor or erdafitinib (if FGFR2 or FGFR3 activating mutation or fusion). The role of locoregional therapy depends mainly on the response on the systemic therapy (unfortunately we don't have high level of evidence for consolidation locoregional therapy after great response to primary non-chemotherapy regimens). Systemic therapy takes priority considering the very high risk of micrometastasis in this setting of nodal metastasis. We need data in the setting of stage III bladder cancer but primary progression on cisplatin-based chemotherapy is very worrisome. Important also to pursue tumor NGS to ...