Although non-metastatic muscle-invasive bladder cancer (MIBC) can potentially be cured with a trimodal approach in well-selected patients, radical cystectomy remains the reference treatment to date. However, there is a significant rate of recurrence after a radical cystectomy. This risk of recurrence is highly stage dependent and recurrences are commonly seen under the form of distant metastases.1 The predominant cause for these recurrences is the presence of occult micrometastases at the time of cystectomy. For this reason, there is interest in combining definitive surgical or radiotherapeutic treatment for localized disease with systemic chemotherapy for occult metastases. In this respect, several randomized controlled trials (RCTs) assessed the efficacy of peri-operative chemotherapy in the management of MIBC. During the 2019 annual BMUC meeting, dr. Nieves Martínez Chanzá reviewed the available peri-operative treatment landscape in MIBC and discussed emerging data on checkpoint inhibitors and predictive biomarkers in this setting.