Authorship note: hr and dsc are co- first authors. sv and jef are co-senior authors. conflict of interest: gs is on the advisory board of bristol myers squibb, genentech, emd serono, merck, sanofi, seattle genetics/ astellas, astrazeneca, exelixis, janssen, bicycle therapeutics, pfizer, immunomedics/gilead, scholar rock, g1 therapeutics, eli lilly/loxo oncology, infinity pharmaceuticals, lucence, and imv. gs reports institutional research support from sanofi, astrazeneca, immunomedics/ gilead, qed, predicine, bristol myers squibb, emd serono, and jazz therapeutics. gs has been a study steering committee member at bristol myers squibb, bavarian nordic, seattle genetics, qed, and g1 therapeutics as well as and astrazeneca, emd serono, and debiopharm and a data safety monitoring committee member at mereo. gs reports travel costs from bristol myers squibb and astrazeneca. gs’s spouse is employed by myriad genetics. gs reports writing/editor fees from uptodate and editor fees from elsevier practice update bladder cancer center of excellence as well as speaking fees from physicians education resource, onclive, research to practice, medscape, cancer network, and masters lecture series