Would you offer neoadjuvant chemotherapy to a patient with high risk non-muscle invasive urothelial carcinoma for whom cystectomy is planned?  

Short answer is no in NMIBC. If there is pT3/4 and/or pN+ path Stage at radical cystectomy, would consider adjuvant therapy options, e.g. cisplatin-based chemo or clinical trial.

There is no role for systemic chemotherapy for high-risk NMIBC. However, pembrolizumab is approved by the US FDA for BCG-unresponsive NMIBC with CIS. Occasionally, in a patient with high-risk NIMBC, a deeper biopsy is considered risky and the MRI is consistent with muscle invasion- although such pat...