Conventional treatment of high-grade, invasive bladder cancer has produced cure rates of only 50% or lower. Systemic cytotoxic chemotherapy has produced response rates of 10–70% in metastatic and recurrent bladder cancer in a series of clinical trials. As a result, cytotoxics have been introduced earlier into the clinical management of invasive bladder cancer, either before and/or after definitive treatment in an attempt to improve treatment results. The current status of these clinical trials of so-called ‘neoadjuvant’, ‘perioperative’ or ‘classic adjuvant’ chemotherapy is reviewed.