Should every patient with muscle-invasive bladder cancer receive neoadjuvant chemotherapy?

The use of cisplatin-based neoadjuvant chemotherapy (NAC) for all patients with muscle-invasive bladder cancer (MIBC) is recommended by current guidelines (1,2). However, the study of Bhindi et al. suggest, that patients not responding to NAC show an inferior survival than a comparable control group (3). Furthermore, only 20–38% of the patients exposed towards NAC show a histopathological response (4). Taking these aspects and the known chemotherapy-related toxicity into consideration leads both, providers and patients, to the question whether the potential benefits of NAC outweigh its disadvantages.