Gastric carcinoma is widespread in many South American and Asian countries but may be especially deadly in the West, due to a lack of programs for early diagnosis. Advanced gastric carcinoma is incurable, and the median survival time of patients with advanced disease is only 6 to 9 months. We sought to examine investigative trends in the utilization of new agents in the treatment of advanced gastric carcinoma in North America and Europe. Representative published reports of phase II and III clinical trials of therapies for gastric carcinoma by investigators based in North America and Europe from January 1995 through December 2001 were identified by a computerized search of the PubMed literature database. Fluorouracil, cisplatin, leucovorin, methotrexate, doxorubicin, and mitomycin were considered "conventional" agents; all other drugs were considered "new" agents. Of the 42 reports identified by the literature search, 17 were by investigators in North America and 25 were by investigators in Europe. All reports by investigators in North America were phase II trials, compared with 64% of those studies in Europe; the other studies by European investigators were phase III trials (36%). Chemotherapeutic drugs we considered "new" for the purpose of this study were investigated in 64% of all trials in North America and Europe. Eighty-one percent (22/27) of the 27 trials in which new agents were studied were phase II studies. We conclude that new agents are being widely incorporated in the investigation of advanced gastric cancer in North America and Europe. This trend is likely to be continued as more new chemotherapeutic agents are developed for clinical testing.