surgery alone, the role of adjuvant therapy has been extensively evaluated. A series of studies has established that 6 months of chemotherapy with either gemcitabine or fluorouracil, as compared with observation, improves overall survival. Newer trials incorporating immune checkpoint inhibitors such as the inhibitors to programmed death 1 (PD-1) and the PD-1 ligand PD-L1 are under way. Lung Cancer Non-small cell lung cancer (NSCLC) In 2015, a comprehensive meta-analysis of 47 trials and 11,107 patients revealed that NSCLC patients benefit from adjuvant therapy in the form of chemotherapy and/or radiotherapy. The results found that patients given chemotherapy after the initial surgery lived 4% longer than those who did not receive chemotherapy. The toxicity resulting from adjuvant chemotherapy was believed to be manageable. Bladder cancer Neoadjuvant chemotherapy (NAC) followed by a radical cystectomy (RC) and pelvic lymph node dissection is current standard of care to treat muscle-invasive bladder cancer (MIBC). NAC was justified for use in MIBC due to a randomized control trial which showed an improved median overall survival (OS; 77 months vs. 46 months, p = 0.06) and downstaging of pathology (pT0 in 38% vs. 15%) in those who received cisplatin-based NAC followed by surgery vs. surgery alone. These findings were later substantiated by a meta-analysis of 11 clinical trials that showed a 5% and 9% absolute improvement in 5-year overall survival and disease free survival, respectively. Neoadjuvant platinum-based chemotherapy has been demonstrated to improve OS in advanced bladder cancer, but there exists some controversy in the administration. Unpredictable patient response remains the drawback of NAC therapy. While it may shrink tumors in some patients, others may not respond to the treatment at all. It has been demonstrated that a delay in surgery of greater than 12 weeks from the time of diagnosis can decrease OS. Thus, the timing for NAC becomes critical, as a course of NAC therapy could delay a RC and allow the tumor to grow and further metastasize. Micometastases cannot be ruled out in locally advanced disease, and surgery alone is not always sufficient for complete cancer control. In certain situations, acquiring precise pathologic staging can make adjuvant chemotherapy (AC) an appealing option. Stage specific pathologic treatment and reduced time to surgery can predict prognosis and the absolute OS benefits in patients with at least cT3 disease A systematic review that studied 7,056 patients showed there was a known 9-11% absolute survival benefit at five