The evolving role of perioperative systemic therapy in bladder cancer

The treatment landscape for muscle-invasive bladder cancer has recently been transformed by two key phase 3 studies of perioperative enfortumab vedotin plus pembrolizumab. These trials have demonstrated significant improvements in event-free survival and overall survival compared with the previous standards of care, marking a new era in the management of patients with muscle-invasive bladder cancer that is no longer defined by cisplatin eligibility. The focus is now shifting toward the identification of additional novel therapeutic targets for further improved outcomes as well as response-guided treatment pathways seeking to optimize both cancer control and survivorship.