Chemotherapy is still the most important component of systemic therapy in gastric cancer. It is not replaced by targeted agents so far. Novel chemotherapies like 5‑fluorouracil (5FU) prodrugs are applied. Agents such as nanoliposomal irinotecan or nanoparticle albumin-bound paclitaxel are still under investigation. In patients overexpressing the epithelial growth factor receptor 2 (HER2), the addition of trastuzumab to classical chemotherapy improves overall survival (OS) substantially and in second line setting the monoclonal antibody ramucirumab shows single agent activity as well as activity in combination with paclitaxel.