Gastric cancer incidence is decreasing in western countries in the last decades. During the last years diagnostic and therapeutic options in gastric cancer have improved substantially. The aim of this short review is to highlight the progress and setbacks in therapy of gastric cancer over the last 10 years and to set them into perspective. Back in 2006 optimal curative treatment was still under debate, palliative first line treatment was standard but no targeted therapy for gastric cancer was available. Second line treatment was indicated rarely if ever in gastric cancer patients and no data were published on phase III level regarding therapy in patients progressing after first line. In this context many relevant papers were published in the last decade that changed current practice.