Patient description: The patient is a 42 year-old postmenopausal woman who had a screening sonogram which revealed an abnormality in the right breast. She had no palpable masses on breast exam. Core biopsy was done and revealed a 1.8 cm infiltrating ductal breast carcinoma in the left upper outer quadrant. Lumpectomy was done and the surgical margins were clear. The tumor was HER2-positive and ER/PR negative. Axillary sampling revealed 1 positive lymph node out of 12 sampled. CXR was unremarkable. She is using “well women” multivitamins daily and no other medication. She smokes frequently and consumes alcohol occasionally. She is in a relation with only one partner and has a history of 3 pregnancies and live births. She breastfed all three children.

Clinical trial eligibility criteria: eligible ages (years): 18.0-999.0,  Bladder Adenocarcinoma Bladder Clear Cell Adenocarcinoma Bladder Mixed Adenocarcinoma Bladder Neuroendocrine Carcinoma Bladder Small Cell Neuroendocrine Carcinoma Bladder Squamous Cell Carcinoma Bladder Urachal Adenocarcinoma Chromophobe Renal Cell Carcinoma Collecting Duct Carcinoma Infiltrating Bladder Lymphoepithelioma-Like Carcinoma Infiltrating Bladder Urothelial Carcinoma Infiltrating Bladder Urothelial Carcinoma With Giant Cells Infiltrating Bladder Urothelial Carcinoma, Nested Variant Infiltrating Bladder Urothelial Carcinoma, Plasmacytoid Variant Infiltrating Bladder Urothelial Carcinoma, Sarcomatoid Variant Kidney Medullary Carcinoma Large Cell Neuroendocrine Carcinoma Metastatic Bladder Carcinoma Metastatic Bladder Large Cell Neuroendocrine Carcinoma Metastatic Bladder Small Cell Neuroendocrine Carcinoma Metastatic Bladder Squamous Cell Carcinoma Metastatic Infiltrating Bladder Urothelial Carcinoma, Clear Cell Variant Metastatic Infiltrating Bladder Urothelial Carcinoma, Lipid-Rich Variant Metastatic Infiltrating Bladder Urothelial Carcinoma, Micropapillary Variant Metastatic Infiltrating Bladder Urothelial Carcinoma, Plasmacytoid Variant Metastatic Infiltrating Bladder Urothelial Carcinoma, Sarcomatoid Variant Metastatic Kidney Medullary Carcinoma Metastatic Malignant Genitourinary System Neoplasm Metastatic Penile Carcinoma Metastatic Prostate Small Cell Neuroendocrine Carcinoma Metastatic Sarcomatoid Renal Cell Carcinoma Metastatic Urethral Carcinoma Papillary Renal Cell Carcinoma Sarcomatoid Renal Cell Carcinoma Stage IV Bladder Cancer AJCC v8 Stage IV Penile Cancer AJCC v8 Stage IV Prostate Cancer AJCC v8 Stage IV Renal Cell Cancer AJCC v8 Stage IV Urethral Cancer AJCC v8 Stage IVA Bladder Cancer AJCC v8 Stage IVA Prostate Cancer AJCC v8 Stage IVB Bladder Cancer AJCC v8 Stage IVB Prostate Cancer AJCC v8 Testicular Leydig Cell Tumor Testicular Sertoli Cell Tumor Urethral Clear Cell Adenocarcinoma Metastatic disease defined as new or progressive lesions on cross-sectional imaging or bone scan. Patients must have at least One measurable site of disease as per Response Evaluation in Solid Tumors (RECIST) version (v) 1.1 One bone lesion on bone scan (tec99 or sodium fluoride [NaF] positron emission tomography [PET]/computed tomography [CT], CT, or magnetic resonance imaging [MRI]) for the bone-only cohort Histologically confirmed diagnosis of one of the following metastatic cohorts Small cell/ neuroendocrine carcinoma of the bladder All urothelial carcinomas with any amount of neuroendocrine differentiation (including small cell differentiation) will be included. If the tumor is purely neuroendocrine, metastasis from another site of origin should be clinically excluded Adenocarcinoma of the bladder, or urachal adenocarcinoma, or bladder/urethra clear cell adenocarcinoma must be pure (per World Health Organization [WHO] definition), (i.e. urothelial carcinoma with glandular differentiation is not considered a pure adenocarcinoma Squamous cell carcinoma of the bladder must be pure (i.e. urothelial carcinoma with squamous differentiation is not considered a pure squamous cell carcinoma)