Dr. Gautam Jayram highlights how adding durvalumab to standard gemcitabine–cisplatin chemotherapy in the NIAGARA trial improves event-free and overall survival without significantly increasing toxicity, reinforcing the value of a perioperative “sandwich” approach. He emphasizes the need to address ongoing undertreatment in community settings and advocates for a multidisciplinary strategy to optimize outcomes in patients with muscle-invasive bladder cancer.