PURPOSE: Gastric cancer is the most common malignacy in Korea, However, standard systemic combination chemotherapy regimen has not been settled for advanced gastric cancer. 5-FU, Cisplatin, and Pirarubicin combination chemotherpay regimen has been tried to evaluate the response rate and toxicity in advanced gastric cancer patients. MATERIALS AND METHODS: Elligibility included biopsy proven inoperable or relapsed adenocarcinoma of stomach with adequate bone marrow, hepatic, and renal functon. Thirty seven patients with histologically confinned locally advanced or metastatic gastric cancer were treated with cisplatin 15 mg/m2 IV day 1~5, pirarubicin 60 mg/m2 day 1, 5-fluorouracil 750 mg/m2 day 1~5 as a continuous intravenous infusion. RESULTS: Twenty nine patients had measurable disease, 5 had received prior chemotherapy. Performance status was 0~1 in 24 and 2 in 13. There was 1 complete response and 13 partial response with an overall response rate of 48.3%(95% confidence interval 29.9~67.1%). The median survival is 7 months(95% confidence interval 5.4~8.6 months) and median response duration is 6 months. 19 patients experienced severe(WHO grade 3~4) leucopenia, 7 was thrombocytopenia, 13 was nausea and vomiting during chemotherapy. 11 patients experienced chemotherapy dose reduction or chemotherapy time delay due to severe hematologic or non-hematologic toxicities. There was no clinically recognizable cardiac toxicities. CONCLUSION: We experienced 48.3% overall response rate, 7 months median survival, and 51.3% severe hematologic toxicities with 5-fluorouracil, pirarubicin and cisplatin combination chemotherapy regimen in advanced or metastatic gastric cancer patients.