Should immune checkpoint inhibitor be held for palliative RT to bladder in patient with metastatic urothelial carcinoma who has stable systemic disease on immunotherapy?

I assume the scenario applies to patients with good systemic disease control on immune checkpoint inhibitor (ICI) but with symptomatic primary tumor of the bladder, e.g. hematuria, pain, and obstruction. It is helpful to have a good discussion between Med Onc & Rad Onc regarding the optimal timing, ...

Pembrolizumab in combination with gemcitabine and concurrent hypofractionated radiotherapy (52 Gy in 20 fractions over 4 weeks, i.e., 1 fraction = 2.6 Gy) was reported to be a safe and efficacious, bladder-sparing investigational regimen for patients with muscle-invasive bladder cancer (MIBC) in a p...