Cisplatin-based neoadjuvant chemotherapy (NAC) has been shown to significantly improve survival in patients with clinically non-metastatic bladder cancer (cT2-4N0M0 MIBC).1–3 However, not every patient is likely to respond to NAC and is, therefore at risk for progression and delay of radical cystectomy (RC).4 Identification of patients who are unlikely to respond to NAC is of paramount importance for clinical decision making and patient counseling in order to avoid overtreatment and minimize unnecessary adverse events. A recent analysis of The Cancer Genome Atlas (TCGA) showed an age-related distribution of total mutational burden, neoantigen load, molecular subtypes, and intra-tumoral immune signaling in MIBC.5 Based on these findings, we hypothesize that there might be an age-dependent response to NAC.