[Evolving Role of Perioperative Immune Checkpoint Inhibitors in Muscle-Invasive Bladder Cancer]

Muscle-invasive bladder cancer (MIBC) is associated with a high risk of recurrence and metastasis, and its prognosis remains unsatisfactory despite radical cystectomy. Perioperative cisplatin-based chemotherapy has long been the standard approach; however, its efficacy is limited, and a substantial proportion of patients are ineligible for cisplatin. In recent years, the introduction of immune checkpoint inhibitors (ICIs) has significantly transformed the treatment landscape of bladder cancer. In the neoadjuvant setting, ICIs alone or in combination with chemotherapy have demonstrated promising pathological complete response rates, suggesting potential benefits even for patients ineligible for cisplatin-based regimens. In the adjuvant setting, randomized trials have shown improvements in disease-free survival, although the benefits are not consistent. Emerging evidence highlights the potential role of circulating tumor DNA as a biomarker to identify patients who are more likely to benefit from adjuvant immunotherapy. Furthermore, recent studies of perioperative combination strategies, including ICIs with chemotherapy or antibody-drug conjugates, have demonstrated encouraging survival outcomes. These advances indicate a shift toward more personalized and biomarker-driven treatment approaches in MIBC. This article provides an overview of current developments in perioperative ICI-based therapies for MIBC.