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Neoadjuvant, cisplatin-based chemotherapy is preferred for muscle invasive urothelial carcinoma (MIBC). he role of adjuvant therapy (including immunotherapy) is unclear. Recently, the phase 3 IMvigor010 found that up to 1 year of adjuvant atezolizumab (a PD-L1 inhibitor) did not improve disease-free survival in patients with high risk, resected muscle invasive urothelial carcinoma. In CheckMate 274, 709 patients with resected muscle invasive urothelial carcinoma (79% bladder cancer) were randomized to placebo or nivolumab (a PD-1 inhibitor) for up to 1 year. In the overall population, adjuvant nivolumab nearly doubled median disease-free survival (DFS) from 10.8→ 20.8 months and increased 6-month DFS from 60.3→ 74.9%. This was driven by significant improvements in survival free from recurrence outside the urothelial tract and distant metastasis. | Bajorin, N Engl J Med 2021