64 yo M with no significant PMH presents with metastatic SCC of the bladder to the lung. He originally presented with urinary obstruction s/p nephrostomy tube placement with preserved CrCl. He has ECOG 1 and remains fully functional. What would be the best treatment?

GU Cancer Specialist

Pure SCC of the bladder is a rare disease, but for initial treatment, I would offer carboplatin/gemcitabine. There are other chemotherapy regimens such as carbo/gem + paclitaxel that have been evaluated in small studies, although data is very limited and toxicity can be tough to justify 3 drug regimen. Would send for molecular profiling to look for targetable alterations, TMB. Reasonable to consider immunotherapy based treatment with Pembrolizumab or immunotherapy clinical trial.