Bladder cancer is one of the most common cancers among males worldwide. According to muscle invasion status, bladder cancer is classified into non-muscle-invasive bladder cancer and muscle-invasive bladder cancer. Muscle-invasive bladder cancer has a high risk of recurrence and metastasis. Even after radical cystectomy, the 5-year survival rate of patients remains relatively low. Neoadjuvant therapy aims to eradicate potential micrometastases, reduce tumor volume and stage, improve surgical resection rates, and increase patient survival rate. This review focuses on neoadjuvant drug therapy for muscle-invasive bladder cancer, systematically summarizes the current neoadjuvant chemotherapy, immunotherapy and targeted therapy, and discusses the advantages, limitations, and future of these treatment strategies.