Background: Doublet chemotherapy regimens such as 5-fluorouracil and irinotecan (FOLFIRI) appear to be viable first-line treatment options in advanced gastric cancer (AGC). A phase III French intergroup study demonstrated a longer time to treatment failure, improved toxicity profile, and no difference in median OS when using FOLFIRI, compared to epirubicin, cisplatin, and capecitabine (ECX). Purpose: To investigate the real-world efficacy of FOLFIRI in AGC. Methods: Patients diagnosed with AGC in Alberta, Canada from 2012-2020 were identified by the Alberta Cancer Registry. Data points that could not be obtained automatically were obtained by retrospective chart review. Survival was compared by Log-Rank analysis or Cox Regression. Factors associated with FOLFIRI use were determined using logistical regression. Results: A total of 285 patients were analyzed. Eighty-four (29%) patients received FOLFIRI as first-line therapy, 69 received ECX (24%), 82 received CX (29%), 31 received EOX (11%), and 19 received FOLFOX (7%). Thirty-six (12.6%) received a subsequent line of therapy, most commonly FOLFIRI (52.8%). Age, sex, topography (cardia v. non-cardia), or morphology (adenocarcinoma v. signet ring cell v. NOS) did not influence the use of FOLFIRI in the first-line setting. Median overall survival with FOLFIRI was 5.8m vs. 7.4m (p = 0.12) when compared to the patients receiving all other regimens. Conclusions: FOLFIRI had comparable efficacy to other first-line regimens in patients with AGC.