Urothelial carcinoma is the predominant histologic type of bladder cancer. After 
30 years of minimal progress in the treatment of advanced-stage disease, recent 
advances in the genomic characterization of urothelial cancer and breakthroughs 
in bladder cancer therapeutics have rejuvenated the field. Nivolumab, 
pembrolizumab, atezolizumab, durvalumab, and avelumab are among the exciting 
recent novel therapeutic advances gaining approvals by the FDA for treatment of 
advanced-stage urothelial carcinoma. Yet the challenge for clinicians is to 
determine the optimal choice of agents as first-line or second-line therapy and 
which offers the best chance for overall survival for the individual patient in 
this rapidly changing field.