This study was conducted to evaluate the effectiveness of a combination of gemcitabine and nedaplatin therapyamong patients with metastatic urothelial carcinoma previously treated with two lines of chemotherapy. BetweenFebruary 2009 and August 2013, 30 patients were treated with gemcitabine and paclitaxel as a second-linechemotherapy. All had received a first-line chemotherapy consisting of methotrexate, vinblastine, doxorubicinand cisplatin. Ten patients who had measurable histologically proven advanced or metastatic urothelialcarcinoma of the urinary bladder and upper urinary tract received gemcitabine 1,000 mg/m2 on days 1, 8 and15 and nedaplatin 70 mg/m2 on day 2 as a third-line chemotherapy. Tumors were assessed by imaging everytwo cycles. The median number of treatment cycles was 3.5. One patient had partial response and three hadstable disease. The disease-control rate was 40%, the median overall survival was 8.8 months and the medianprogression-free survival was 5.0 months. The median overall survival times for the first-line and second-linetherapies were 29.1 and 13.9 months, respectively. Among disease-controlled patients (n=4), median overallsurvival was 14.2 months. Myelosuppression was the most common toxicity. There were no therapy-relateddeaths. Gemcitabine and nedaplatin chemotherapy is a favorable third-line chemotherapeutic option for patientswith metastatic urothelial carcinoma. Given the safety and benefit profile seen in this study, further prospectivetrials are warranted given the implications of our results with regard to strategic chemotherapy for patientswith advanced or metastatic urothelial carcinoma.