The role of targeted therapies and immunotherapies is evolving. Trastuzumab in combination with chemotherapy is currently the only targeted drug shown to improve survival over chemotherapy alone in a subset of patients with HER2-positive metastatic adenocarcinoma involving the stomach or gastro-oesophageal junction. A few randomised studies also suggest modest benefit from immunotherapy in later disease stages (Janjigian et al. 2018; Kang et al. 2017). Recent trials have demonstrated improvement in survival and fewer adverse effects with anti-PDL1 immunotherapy either as monotherapy or in combination with chemotherapy in patients with tumours that have high expression of programmed cell death ligand 1 (PD-L1), with a combined positive score (CPS) ≥ 10, or deficient mismatch repair (dMMR)/high levels of microsatellite instability (MSI) (Bristol Myers Squibb 2020; Tabernero et al. 2019). However, apart from trastuzumab, immunotherapy is currently not reimbursed by the Pharmaceutical Benefits Scheme, and where possible patients should be encouraged to enrol in clinical trials.