Combination chemotherapy with etoposide, leucovorin and 5-FU (ELF) was investigated in a phase-II study in patients with advanced gastric carcinoma (stage III and IV). Only ambulatory patients (performance status WHO ≤2) above 65 years or younger patients with cardiac disease were entered. A remission rate of 53% could be achieved in 51 evaluable patients, including 12% complete remissions. One toxic death was observed. Remission rate was particularly high in patients with locally advanced disease (70%, 7/10 patients). Median remission duration was 8 months, median overall survival 11.5 months. Patients with peritoneal carcinosis lived significantly shorter than those with other distant metastases (P < 0.05). ELF was well tolerable. The efficacy of ELF, combined with its moderate toxicity, make this therapy a useful approach in the treatment of gastric cancer, where treatment intention is palliative so fa