A consortium of Northern California and Japanese investigators studied 142 patients with advanced gastric adenocarcinoma. Patients were randomized to one of two combination chemotherapy programs in each nation (one common therapy shared and one therapy unique to each nation). Median duration of survival ranged between 5 and 45 weeks, depending on performance status, extent of disease, and chemotherapy program. More importantly, there was considerable comparability with respect to toxicity and outcome between patients in the US and Japan. Overall median survival was 26 weeks for Japanese and 27 weeks for US patients. This study helps provide the basis for future comparative multinational trials.