Muscle-invasive bladder cancer (MIBC) is an aggressive but curable disease. Long-term cure rates however remain suboptimal (40-60%), and are even lower (25-35%) in patients with high-risk disease (T3/T4 or node positive). This is likely due to the presence of micro-metastases at presentation.1,2 Neoadjuvant cisplatin-based combination chemotherapy (NAC) is the standard of care in MIBC. NAC can eradicate micro-metastases and can achieve a pathologic complete response in approximately 30% of patients, and can improve absolute overall survival (OS) rates by approximately 5%.3–5