Summary Background Until recently, chemotherapy of gastric cancer was regarded as only marginally active when used with palliative intention or perioperatively. Methods This is a critical review of the chemotherapy trials being published in gastric carcinoma since 1980. Results During the past 10 years a number of new and active combinations had been developed, which induced 40 to 60% of objective remissions (mostly in phase-II-trials) and up to 10% of clinically complete remissions (in part pathologically confirmed) in locally advanced or metastasized tumors. With these regimens, median survival times of 9 to 11 months were achieved. Moreover, it was shown that a chemotherapy induced reduction of local tumor spread may allow R0-resection of primarily irresectable disease and that chemotherapy can be also used with curative intention. Conclusions Because of these results, gastric cancer can be regarded as a chemosensitive tumor.