Invasive bladder cancer has been associated with a 5-year survival rate of only 50–60% when treated by radiotherapy or chemotherapy alone. Attempts to improve this outcome have included the combination of cytotoxic chemotherapy with definitive local treatment in neoadjuvant, concurrent, or adjuvant regimens. To date, randomized clinical trials have failed to show a survival benefit from neoadjuvant or concurrent schedules but adjuvant chemotherapy is associated with a disease-free survival benefit. New cytotoxic agents, such as paclitaxel and gemcitabine, are active in the management of metastatic bladder cancer and may contribute to improved outcomes for patients with this disease.