Would you consider neoadjuvant chemotherapy for patients with muscle-invasive bladder cancer who are cisplatin-ineligible?

We have level 1 evidence supporting neoadjuvant cisplatin-based chemotherapy followed by cystectomy, there is no evidence supporting non-cisplatin based chemotherapy. Patients unfit for cisplatin should proceed directly to surgery.

Prior to 2025, the answer to this question would be no in the United States. Cisplatin was considered the most active drug to include in neoadjuvant therapy of MIBC prior to radical cystectomy, and for patients who were not eligible to receive it due to medical conditions or renal function, or refus...