Enfortumab Vedotin and Stereotactic Radiation for Localized, Cisplatin Ineligible Muscle Invasive Bladder Cancer

Inclusion Criteria:

1. Urothelial carcinoma of the urinary bladder stage cT2-4a (AJCC 8th edition) N0M0planned for radical cystectomy. Mixed cell types are allowed as long as urothelialcomponent is >50% AND no small cell/neuroendocrine or plasmacytoid/signet ringcomponent.

2. Ineligibility for cisplatin-based chemotherapy based on treating physicianassessment and any of the following "Galsky criteria": renal insufficiency (Creatinine Clearance <60ml/min by standard institutional calculation method), >=grade 2 peripheral neuropathy, >=grade 2 hearing loss, New York Heart Association (NYHA) class III heart failure; a combination of these; or patient refusal.

3. Age >=18.

4. Performance status Eastern Cooperative Oncology Group (ECOG) 0-1

5. Adequate organ and marrow function as defined below:

•Hematologic:

-Absolute neutrophil count (ANC) >=1500/mm3

• Platelet count >=100x109/L

• Hemoglobin ≥ 9 g/dL •Hepatic:

• Serum bilirubin ≤ 1.5 × upper limit of normal (ULN) or ≤ 3 × ULN for subjectswith Gilbert's disease

• Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 2.5 × ULN •Renal:

• No end stage renal disease requiring dialysis allowed

6. All men, as well as women of child-bearing potential must agree to use adequatecontraception (hormonal or barrier method of birth control; abstinence) prior tostudy entry, for the duration of study participation, and for 3 months followingcompletion of study neoadjuvant therapy. Should a woman become pregnant or suspectshe is pregnant while participating in this study, she should inform her treatingphysician immediately.

6a. A female of child-bearing potential is any woman (regardless of sexual orientation, marital status, having undergone a tubal ligation, or remaining celibate by choice) who meets the following criteria:

• Has not undergone a hysterectomy or bilateral oophorectomy; or

• Has not been naturally postmenopausal for at least 12 consecutive months (i.e., hashad menses at any time in the preceding 12 consecutive months).

7.Ability to understand and the willingness to sign a written informed consent.

Exclusion Criteria:

1. No prior systemic therapy (except prior therapy for non-muscle invasive bladdercancer >12 prior to registration) for bladder cancer or prior pelvic radiotherapy.Prior intra-vesical therapies are allowed, including Bacillus Calmette-Guerin (BCG)for non-muscle invasive bladder cancer. Prior chemotherapy for other cancers isallowed if given >=1 year prior to study registration.

2. Baseline >= Grade 2 sensory or motor neuropathy

3. Subjects may not be receiving any other investigational agents for the treatment ofthe cancer under study.

4. History of allergic reactions attributed to compounds of similar chemical orbiologic composition to enfortumab vedotin or other agents used in study.

5. Uncontrolled intercurrent illness including, but not limited to, ongoing or activeinfection, symptomatic congestive heart failure, unstable angina pectoris, cardiacarrhythmia, or psychiatric illness/social situations that, in the opinion of theinvestigator, would limit compliance with study requirements.

6. Subjects must not be pregnant or nursing due to the potential for congenitalabnormalities and the potential of this regimen to harm nursing infants.