MVAC (methotrexate, vinblastine, doxorubicin [adriamycin] and cisplatin) is the standard chemotherapy regimen for advanced bladder cancer, but this combination is associated with substantial toxicity. Researchers are now trying to replace the MVA of MVAC with gemcitabine, a drug known for its ‘kinder, gentler’ toxicity profile. A recent trial combining gemcitabine with cisplatin was described at the Chemotherapy Foundation Symposium XV [New York, US; November, 1997]. And a new multinational phase III trial has just begun which directly compares MVAC with gemcitabine/cisplatin for metastatic urothelial cancer.