Gastric cancer remains a leading cause of cancer deaths worldwide. Surgical resection is required for potential long-term cure; however, 5-year survival remains poor unless the disease is confined to the superficial layers. Studies demonstrate failure to be most commonly locoregional relapse. Adjuvant therapy, therefore, has a potentially important role in the treatment of patients with resectable gastric cancer. Recently, attention has been focused on neoadjuvant therapy with it concomitant theoretical advantages. A neoadjuvant strategy may offer the patient significant benefit by exposing micrometastases to chemotherapy early and, thereby, enhancing resectability due to chemoradiation-induced tumor down-staging. Furthermore, neoadjuvant therapy would provide a means to assess both clinical and pathologic responses to determine potential benefits of additional treatment after surgical resection. In addition, a neoadjuvant strategy would provide a means to identify patients with rapid disease progression and, therefore, would not benefit from a gastric resection. New studies have determined that preoperative chemotherapy for potentially resectable gastric cancer results in a high rate of tumor downstaging, and response to preoperative chemotherapy best predicts survival. Clinical trials are underway to determine the efficacy of neoadjuvant therapy on overall survival in gastric cancer.