Are there scenarios where you would still prefer adjuvant nivolumab based on known pathologic risk over using perioperative durvalumab for all patients with muscle invasive bladder cancer?  

Adjuvant nivolumab can still be considered for patients who fit the criteria for CheckMate 274, which led to the approval of this regimen. Specifically, this refers to patients who have not had perioperative chemotherapy and have high-risk disease at the time of radical cystectomy (≥pT3N0) or pat...

Perhaps for patients with lower clinical risks, cT2, cN0, I might consider neoadjuvant chemotherapy alone, and decide on adjuvant nivolumab accordingly based on the final pathologic stage. This is especially if I am concerned about the immunologic side effects by adding immunotherapy on top of chemo...