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Introduction and Objectives. Urothelial carcinomas in the advanced stage is usually initially treated with platinum salts in the case of eligible patients or carboplatin and gemcitabine in the case of those with a significant degree of renal insufficiency, only when the disease progresses and becomes unresponsive the current trials of immunotherapy treatment have shown encouraging result regarding its use. Materials and Methods. This is a case of a 67 years old male patient, smoker, who underwent left total nephroureterectomy with perimeatic cystectomy and excision of a left ilioobturator adenopathy of the first intention due to the fact that the patient had hematuria with secondary anemia, the histopathological result being invasive urothelial carcinoma, high grade of malignancy, high grade of anaplasia (G3), pT3N1M3, who developed tumor recurrence which ultimately showed significant results of regression under immunotherapy with Pembrolizumab. Results. Nephroureterectomy performed with perimeatic cystectomy and tumor lymph node excision showed the histopathological result of invasive urothelial carcinoma pT3N1 high grade, but the degree of renal insufficiency established after the operation required the initial use of adjuvant treatment consisting of Carboplatin + Gemcitabine, the patient not being eligible for salts of platinum, and external radiotherapy. Follow-up serial imaging showed the progression of the disease, which is why, following the genetic tests performed, the patient showed positive expression for PD-L1, thus beginning treatment with Pembrolizumab, under which a significant regression of the lesions was observed. Conclusions. The treatment with Pembrolizumab has proven its effectiveness both through imaging and clinical data and brings one more argument in the use and result of immunotherapy in urothelial carcinoma. [ABSTRACT FROM AUTHOR]