The treatment of metastatic urothelial cancer (UC) of the bladder using immunotherapy is a field of rapid growth and development. We report the case of a 72 year old man who has had remarkable improvement in his metastatic urothelial cancer with nivolumab therapy after failure of chemotherapy. He had initially undergone surgical resection, multiple cycles of chemotherapy and radiotherapy before developing lung metastases. As he was unable to tolerate further chemotherapy and his lung metastases were progressing, nivolumab was initiated. After 11 months of nivolumab his clinical symptoms have improved and his lung metastases have completely resolved radiologically. Results from phase I and II clinical trials have indicated that nivolumab can have a meaningful and lasting response in patients with metastatic UC who have progressed on platinum based therapy (1, 2). Our case supports this and this approach has potential utility in patients who are unable to tolerate platinum based chemotherapy.