This clinical trial is focused on studying treatments for muscle-invasive bladder cancer, a type of cancer that affects the bladder muscle. The study involves the use of two medications: pembrolizumab, also known by its code name MK-3475, and enfortumab vedotin. Pembrolizumab is a medication that helps the immune system fight cancer cells, while enfortumab vedotin is a drug that targets and kills cancer cells directly. The purpose of the study is to compare the effectiveness of different treatment combinations in improving the time patients remain free from cancer-related events.

Participants in the study will be divided into different groups. One group will receive pembrolizumab along with a surgical procedure called a cystectomy, which involves removing the bladder. Another group will receive both pembrolizumab and enfortumab vedotin, along with the cystectomy. There is also a group that will undergo the cystectomy alone. The study will observe how these treatments affect the participants over time, focusing on how long they remain free from cancer-related events and their overall survival.

The study aims to provide valuable information on the potential benefits of combining these medications with surgery for patients who cannot or choose not to receive a common chemotherapy drug called cisplatin. By comparing these different approaches, researchers hope to find more effective treatment options for individuals with muscle-invasive bladder cancer. Participants will receive the treatments through an intravenous infusion, which means the medication is given directly into a vein.