Of all patients with gastric cancer 80 % to 90 % are either diagnosed at an advanced stage when the tumour is inoperable, or within five years after surgery a recurrence develops. Chemotherapy clearly improves survival in comparison to the best supportive care only. In addition, combination of chemotherapy further improves survival compared to single-agent 5-FU. However, combination of chemotherapies has higher rates of adverse effects, and their impact on the patient’s quality of life has not been adequately studied. 5-FU/platinum combinations, with or without an anthracycline, as well as irinotecan and docetaxel-containing combinations are reasonable current treatment options. The development of targeted therapies in gastric cancer clearly stays behind the integration of these novel agents into new treatment concepts for patients with colorectal cancer.