Atezolizumab Plus Etoposide and Platinum in Small Cell Bladder Cancer

Inclusion Criteria: * Histologically confirmed invasive carcinoma of the bladder with pure, or any component of, small cell or high grade neuroendocrine features with or without urothelial cancer - localized ≥ cT1-T4aN1 A formalin-fixed paraffin-embedded (FFPE) tumor specimen in a paraffin block (preferred) or at least 15 slides containing unstained, freshly cut, serial sections should be submitted along with an associated pathology report prior to study enrollment. If less than 15 slides are available, the patient may still be eligible for the study, after Principal Investigator confirmation has been obtained. If archival tumor tissue is unavailable or is determined to be unsuitable for required testing, tumor tissue must be obtained from a biopsy performed at screening. * Medically fit to undergo chemotherapy, immunotherapy and cystectomy * 18 years old at time of consent * ECOG performance status of 0 or 1 * Adequate hematologic and end organ function, defined by the following laboratory results obtained within 14 days prior to randomization: * ANC ≥ 1500 cells/μL without granulocyte colony-stimulating factor support * Lymphocyte count ≥ 500/μL * Platelet count ≥ 100,000/μL without transfusion * Hemoglobin ≥ 9.0 g/dL -patients may be transfused to meet this criterion. * INR or aPTT ≤ 1.5 × upper limit of normal (ULN) This applies only to patients who are not receiving therapeutic anticoagulation; patients receiving therapeutic anticoagulation should be on a stable dose…