Background: Neoadjuvant chemotherapy (NAC) with either Gemcitabine-Cisplatin (GC) or Dose-Dense Methotrexate, Vinblastine, Doxorubicin, and Cisplatin (DD-MVAC) is a standard approach for muscle-invasive bladder cancer (MIBC). While efficacy is established, toxicity profiles may differ and impact treatment delivery. This retrospective study compares the toxicity of GC and DD-MVAC regimens at the Moulay Ismail Military Hospital in Meknes. Methods: We retrospectively analyzed the records of 21 patients with MIBC treated with NAC between January 2020 and December 2023 (Corrected Date): 14 received GC (Gemcitabine 1000 mg/m² D1, D8; Cisplatin 70 mg/m² D1, q21 days) and 7 received DD-MVAC (Methotrexate 30 mg/m² D1; Vinblastine 3 mg/m² D2; Doxorubicin 30 mg/m² D2; Cisplatin 70 mg/m² D2, q14 days with G-CSF support). Toxicities were graded according to NCI-CTCAE v5.0. Results were compared descriptively and contextualized with published data. Results: In the GC group (n=14), the most frequent grade ≥3 toxicities were neutropenia (21.4%), anemia (14.3%), and thrombocytopenia (7.1%). Grade 1-2 renal toxicity occurred in 21.4%. In the DD-MVAC group (n=7), grade ≥3 neutropenia (42.9%) and mucositis (28.6%) were predominant. Two cases (28.6%) of febrile neutropenia were observed in the DD-MVAC arm (Corrected Number). Grade 1-2 renal toxicity was noted in 28.6% of DD-MVAC patients, and one case (14.3%) of Grade 3 renal toxicity occurred. All patients completed their planned NAC regimen, except for one patient (DD-MVAC arm) who discontinued due to Grade 3 renal toxicity. Conclusion: In our small cohort, both NAC regimens induced significant toxicity. DD-MVAC appeared associated with higher rates of severe neutropenia and mucositis compared to GC. These findings, although limited by sample size, underscore the need for vigilant monitoring and proactive toxicity management for both regimens in our setting, potentially favoring GC in patients perceived as more vulnerable to