The identification of predictive biomarkers is useful for treatment selection in bladder cancer. Here, Yair Lotan, MD, of the University of Texas Southwestern Medical Center, Dallas, TX, reports that mutations in DNA damage repair genes are often associated with poor responses to chemotherapy. Considering the toxicity involved in chemotherapy, Prof. Lotan summarizes that it may be beneficial for patients who are less likely to have positive outcomes from chemotherapy to be given alternative therapies. This video was recorded at the 2019 Genitourinary Cancers Symposium, held in San Francisco, CA.