What treatment would you consider for small cell neuroendocrine carcinoma of the bladder with a metastatic recurrence within 3 months of neoadjuvant cisplatin/etoposide followed by radical cystectomy (ypT0N0)?

Very poor prognosis with early recurrence in a very aggressive histology despite pCR in the primary tumor reflecting tumor heterogeneity and implying platinum resistance in the recurrence tissue. Would evaluate NGS for potential “actionable” genomic alterations and also consider clinical trials (e.g...

Caveat that I am a gastrointestinal oncologist so do not treat neuroendocrine from the bladder per se, that said, we see the majority of high-grade neuroendocrine carcinomas in our department. I would not offer PD-1 alone. Instead, I would offer Ipilimumab/Nivolumab on the basis of the DART/SWOG 160...