In a medically inoperable, elderly, frail patient with muscle invasive, node negative bladder cancer, would you consider combining immunotherapy with radiotherapy instead of chemotherapy?  

Maybe but what about using low dose Gemcitabine ( 27mg/M2 twice weekly) with daily XRT as in NEG 0712?  This seems much better to me!  WS

Now in 2021, with evidence of activity of immunotherapy in MIBC, how would you manage an otherwise healthy older (>70) patient with elevated creatinine, not a candidate for cisplatin? Would you still advise Gem? Or consider 5-FU/mitomycin, or perhaps IO therapy followed by chemo-RT or IO-RT?