Gastric cancer is still a devastating disease. Two thirds of the patients are diagnosed in a locally advanced or metastatic stage. Even if surgery is possible, long-term survival is low. Optimal therapy in a curative and a palliative setting is still not clear yet. ASCO 2010 could shed some light on optimal chemotherapy and the introduction of molecular targeted therapy. The aim of this article is to summarize the most important publications at this year's ASCO annual meeting and to put them into context of current therapeutic strategies.