Forty-two patients with measureable, advanced, genito-urinary cancer received Adriamycin. Significant clinical responses (CR/PR) occurred in only five (14%) of 35 adequately treated patients. Four additional patients achieved a minimal response anf four others showed stabilization of their disease for 4 to 9 months. Review of the literature suggests an overall response rate of 20%. Patients with a urinary diversion lived significantly longer (P 0.006) than patients who did not have this procedure (42.5 months vs 21.5 months). The need to define various patient characteristics in future chemotherapeutic trials in bladder cancer is discussed.