Introduction: Elderly patients are under-represented in the clinical trials of patients with metastatic gastric cancer (GC); therefore, the efficacy and tolerability of palliative chemotherapy areunclear in these patients. We aimed to assess the efficacy and tolerability of first-line palliativechemotherapy in elderly patients (age >=70 years) with metastatic GC.Materials and Method: From 2005 to 2014, 89 patients with metastatic GC who were 70years and older and were treated with at least two cycles of systemic chemotherapy as first-linetreatment were included retrospectively. Disease and patient characteristics, prognostic factors,treatment response, grade 3-4 toxicity related to treatment, progression free survival (PFS), andoverall survival (OS) were evaluated.Results: Of the 89 patients, 65 (73%) were males; median age was 74 (70-84) years. Themedian follow-up period was 7 months (min-max: 2-57 months), median PFS was 5 months(95% CI: 3.7-6.3), and median OS was 7 months (95 % CI: 5.2-8.9). The disease was controlled in 43.8% patients, whereas progression was observed in 56.2% patients. Univariate analysisshowed that the Eastern Cooperative Oncology Group (ECOG) performance status, number ofchemotherapy cycles, and response to the first line chemotherapy had a significant effect on PFSand OS; liver metastasis had an effect only on PFS; lung metastasis had an effect only on OS. Conclusion: Fewer chemotherapy cycles, lung metastasis, liver metastasis, and poor ECOGperformance scores were found to be poor prognostic factors.