© 2019 European Association of Urology Neoadjuvant chemotherapy has proven clinical benefit in muscle- invasive bladder cancer. Cisplatin is the likely driver of this benefit. Textbook definitions of cisplatin ineligibility may restrict almost 50% of patients from therapy. Checkpoint inhibitors (anti– PD-1 antibodies and anti– CTLA-4 antibodies) are currently in clinical trials for neoadjuvant use. Initial data from these studies appear promising.