Seventeen patients with advanced renal pelvic and ureteral carcinoma receiving M-VAC chemotherapy were evaluated. There were 10 men and 7 women ranging in age from forty-two to seventy-eight years with a mean of sixty-six years. The primary sites of carcinoma were renal pelvis in 4 patients, ureter in 12, renal pelvis and ureter in 1. Fifteen patients had transitional cell carcinoma, one patient had transitional cell carcinoma mixed with squamous cell carcinoma and the histology of one patient was not identified. The median number of treatment cycles was 2.6, ranging from 1 to 6. Significant remissions following the treatment were observed in 5 of 8 primary lesions, 6 of 11 lymph nodes, 2 of 3 lung lesions and 2 of 5 bone lesions, respectively. However, the responses were not seen in 4 liver lesions. Two patients achieved a complete response (CR), 7 had a partial response (PR), 6 had stabilization of their disease, 2 had progressed, and the overall response rate was 52.9%. Two CR patients remain free of disease. Relapse or recurrence was seen in 4 of the 7 patients who achieved PR, and the median duration of response was 6.4 months. While the myelosuppression with this regimen was tolerable, the decreases of white blood cell and platelets count were significant in patients who had undergone prior irradiation. These results indicate that the M-VAC regimen is effective in patients with advanced upper urothelial malignancy. Further, a short response and a poor effectiveness in the metastases of liver and bone remain to be overcome.