Background: Urothelial carcinoma represents 3% of new cancer cases globally. Metastatic urothelial carcinoma (mUC) poses a notable challenge to healthcare systems, given its treatment complexity and high mortality. These challenges are magnified in resource-constrained settings. We aim to describe treatment trends for mUC across public and private Mexican centers. Methods: Retrospective study across 8 referral centers. Adults with mUC from 01/2001-12/2021 were included. We assessed clinical records, demographics and comorbidities. We recorded subject eligibility for first line platinum therapy, treatment lines received, and access to novel drugs. Descriptive statistics were used for demographics, treatment details and outcomes. Survival analysis was performed, including Kaplan Meier curves and Cox proportional hazards model. Results: We found 342 cases of mUC, 76% were male, with a median age of 67 years. Median follow-up was 8.4 months. Among those that received a first line (n=223, 65%), regimens used were cisplatin-based chemotherapy (n=100, 45%), carboplatin-based chemotherapy (n=87, 39%), gemcitabine (n=5, 2.2%), immunotherapy (n=4, 1.8%) or unspecified (n=27, 12%). Most causes of cisplatin ineligibility were ECOG ≥2 (41%) and glomerular filtration rate <60 ml/min (33%). Of those who received upfront platinum therapy (n=187), 65% received >3 cycles (n=121), 20% received 2 or 3 cycles (n=38) and 15% received 1 cycle (n=28). Progression as best response was found in 47% (n=88). Avelumab maintenance was only used in 14/99 eligible patients (14.1%). The proportion of individuals receiving a second, third or more lines was 24.6%, 8.8% and 3.5%, respectively. The most common second line treatment was chemotherapy (64.4%) followed by immunotherapy (28.6%). Median overall survival (mOS) was 11.8 months. Treatment notably impacted mOS, favoring those who received a first line(16.7 vs. 4.6 months, p<0.0001). Stratified analysis showed worse mOS for those with visceral disease (17.1 vs 10.3 months, p=0.0065) and ECOG ≥2 (17.6 vs 5.8 months, p<0.001).These features correlated with higher mortality, while first line treatment was associated with lower mortality. Conclusions: These data represent the first effort to delineate treatment trends of mUC in Mexico. First line treatment rates were higher than those described worldwide (35-60%¹). Further, cisplatin-eligibility was higher compared to reports of high-income countries. Considerable rates of progression to platinum therapy were found, likely due to aggressive disease. This study highlights the limited access to novel treatments, showed by the infrequent use of avelumab maintenance, immunotherapy or targeted agents.