Background: Gemcitabine + cisplatin may be a promising regimen for advanced upper-tract urothelial carcinoma (UTUC) as well as for advanced bladder cancer. However, cisplatin is proved to be too toxic for the patients with impaired renal function and aged patients. Majority of aged patients with UTUC have impaired renal function. There is no standard regimen for such patients. We assessed the effectiveness and adverse events (AEs) of a sequential chemotherapy with Gemcitabine plus carboplatin(GCarbo) followed by GCcarbo plus docetaxel (GCarboD) for advanced UTUC. Methods: We treated 86 patients with advanced UTUC at our clinic between August 2004 and December 2013. 45 patients (31 men and 14 women) with the age of 65 years or older were enrolled. Mean age was 73.0 (65–89), and mean Ccr was 47.9 (11.6–99.2) ml/minute. Mean observation period was 22.9 (3–87.2) months. The therapeutic regimen consisted of 2 lines: GCarbo therapy as the first line, with two courses as a set; GCarboD therapy as the second line if the response in the first line was insufficient. If this regimen was effective, another 2 courses of GCarbo was performed. If this regimen did not induce any tumor size reduction, we switched to GCarboD. Results: GCarbo regimen yielded 1 cases (2.2%) of CR, 20 (44.4%) of PR, and the mean duration of response of 11.0(3–51) months. GCarboD treatment was administered in 12cases, and yielded one (8.3%) PR and a duration of response was 7.0 months. The median survival period was 14.0 months with GCcarbo/GCarboD regimens. As for ARs with GCcarbo regimen, there were 23 (52.2%) of G3/4 blood toxicity. In GCarboD regimen, there were 11 (91.7%) of blood toxicity and 7 (58.3%) of gastrointestinal AEs. Conclusions: Although the present study is small and preliminary, the present sequential chemotherapy is safe and active for advanced UTUC of the patients sixty-five years or older. GCarbo regimen achieved relatively high response rate (46.6%) in advanced UTUC. The median overall survival of 14.0 months is acceptable when average age of 73.0 year for the subjects is took into consideration. However, GCarboD had limited effectiveness for non-responder of GCarbo.