Over the past decade, a large amount of information has been acquired regarding the use of chemotherapy for metastatic bladder cancer. Combination regimens including M-VAC and CMV have been developed that generate high response rates; however, the impact of chemotherapy on survival has been modest. The available data would strongly suggest that therapy needs to be improved, and therefore current regimens should not be considered the standards of care as much as the standards of comparison for improved future treatments.