Patients with advanced transitional cell bladder carcinoma were randomized to receive adriamycin alone, or adriamycin plus DDP [cis-diamminedichloroplatinum]. Overall response was 8/41 (19%) for adriamycin alone vs. 16/37 (43%) for the combination (P = 0.02). Median response duration was 14 wk for adriamycin vs. 25 wk for the combination (P = 0.17). Median survival was 28 wk on adriamycin vs. 31 wk on the combination (P = 0.82). Median survival of responders was 43 wk; for patients with stable disease it was 29 wk. This was significantly better than for those with increasing disease at 15 wk (P = 0.02). Increased frequency of leukopenia and gastrointestinal toxicity were seen with the combination. Cardiotoxicity and nephrotoxicity were not prohibitive.