Practice-changing perioperative data are reshaping care for muscle‑invasive bladder cancer. - An international phase 3 trial published in NEJM showed that enfortumab vedotin pembrolizumab improves survival and reduces risk of recurrence after surgery. - Phase II SKYSCRAPER‑05 reported promising neoadjuvant activity for tiragolumab (anti‑TIGIT) atezolizumab chemotherapy (overall response rate 66%, major pathologic response 51%). - A recent network meta‑analysis has helped clarify optimal perioperative strategies for MIBC, and experts say these comparative results are prompting shifts in treatment sequencing — particularly for cisplatin‑eligible patients (the discussion is moving from whether to use EV pembrolizumab to how to use it). - Leaders in the field also note that precision oncology is increasingly influencing urothelial carcinoma management. These developments are moving standards of care and will affect how clinicians sequence neoadjuvant and adjuvant options. Links: NEJM phase 3 report (enfortumab vedotin pembrolizumab); SKYSCRAPER‑05 summary; network meta‑analysis commentary.