A large international trial found that combining immunotherapy with a targeted drug before surgery reduced death risk in bladder cancer patients who could not receive standard chemotherapy. The study reported a 42% reduction in risk, with results framed around perioperative treatment impact in a population with limited options. The trial’s emphasis on a pre-surgical strategy reinforces the growing focus on neoadjuvant systemic therapy as a way to improve survival outcomes and downstream disease control in urothelial cancer cohorts.