Inclusion Criteria:

- Histologically proven locally advanced disease or metastatic transitional cell
carcinoma of the urothelium including bladder, urethra, ureter, and renal pelvis.
Patients should not be suitable for surgery or radiation with curative intent.
However patients whose pre-chemotherapy sites of disease are restricted to the
primary or regional lymph node sites and who have a major response to chemotherapy
will be evaluated for post-chemotherapy surgical resection of residual cancer if the
tumor has become resectable at the end of chemotherapy.

- Measurable disease status, as defined in the Response Evaluation Criteria in Solid
Tumors (RECIST) criteria (Therasse et al., 2000)

- One course of prior radiation therapy is allowed. Prior radiation must have been
completed at least 4 weeks before enrolment into the study and the patients must have
recovered from all toxic effects.

Exclusion Criteria:

- Have central nervous system (CNS) or leptomeningeal metastases (unless the patient
has completed successful local therapy for CNS metastases and has been off
corticosteroids for at least 4 weeks before starting study therapy). A screening
computed tomography (CT) or magnetic resonance imaging (MRI) before enrollment in the
absence of a clinical suspicion of brain metastases is not required.

- Inability to interrupt aspirin or other nonsteroidal anti-inflammatory agents 2 days
before, the day of, and 2 days after the dose of pemetrexed plus cisplatin or
cisplatin alone. If a patient is taking a nonsteroidal anti-inflammatory drug
(NSAID) or salicylate with a long half-life (for example, naproxen, piroxicam,
diflunisal) it should not be taken 5 days before the dose of pemetrexed (8-day period
for long-acting agents such as piroxicam), the day of, and 2 days after the dose of
pemetrexed plus cisplatin.