In 2009, a randomized clinical trial (RCT) showed better survival for patients with advanced ERBB2-positive gastric cancer who received trastuzumab in addition to chemotherapy.8 It took 1 year until formal approval was granted for this new indication by the US Food and Drug Administration (FDA),9 and during this time, patients with ERBB2-positive advanced gastric cancer could only receive trastuzumab via off-label use. This evidence concerns the gene ERBB2 and gastric cancer.