What is your approach to a patient with muscle invasive bladder cancer getting neoadjuvant gemcitabine/cisplatin who develops significant ototoxicity due to cisplatin after two cycles?

My approach would be to proceed to surgery and based on pathological response, determine if the patient is a candidate for nivolumab.

For patients who cannot tolerate cisplatin, there is no recommendation for an alternate regimen in the neoadjuvant setting.

If treatment-naive and cisplatin-ineligible ...