Understanding the cellular mechanisms governing therapy response is essential to optimize immunotherapies. Tian Zhang, MD, of Duke Cancer Center, Durham, NC, discusses her group’s investigation of the changes that accompany metastatic urothelial cancer (mUC) treatment. Her group used multidimentional flow cytometry to perform molecular profiling of patients’ peripheral blood mononuclear cells; these were patients with cisplatin-resistant mUC who were treated with either pembrolizumab alone or with pembrolizumab plus acalabrutinib. Speaking at the 2019 Genitourinary Cancers Symposium, held in San Francisco, CA, Dr Zhang reports that this approach could not only help elucidate the immune characteristics of mUC patients, but also potentially guide clinical decision making in the future.