“Primary” and “secondary” muscle-invasive bladder cancer is more than just a surrogate for molecular subtypes

We would like to thank Drs. Szarvas, Olah, and Reis for their thoughtful and insightful comments regarding our recent publication on patients who initially present with muscle-invasive bladder cancer (“primary” MIBC) compared to patients with non-muscle-invasive bladder cancer (NMIBC) who unfortunately experience progression to MIBC (“secondary” MIBC). As this latter group account for only 15–20% of MIBC patients, such patients were underrepresented in the clinical trials from which guidelines for neoadjuvant chemotherapy were based.