Abstract: Objective To evaluate the efficacy and safety of apatinib in advanced alpha fetoprotein （AFP）-positive gastric cancer. Methods Seven patients with advanced AFP-positive gastric cancer from September 2009 to January 2017 received apatinib were enrolled. All the patients were given apatinib alone or in combination with chemotherapy， and the dose of apatinib was 250-850 mg／d. The efficacy and safety were evaluated by RECIST criteria （version 1.1） and NCI CTC 4.0 criteria. Overall survival （OS） and progression-free survival （PFS） were analyzed by Kaplan-Meier method. Results All patients were available for evaluation. Among the 7 patients， 1 case got partial respond and 3 cases had stable disease. The response rate was 14.3% and disease control rate was 57.1%. The median PFS was 4.0 months （95%CI： 0-9.1） and the median OS was 7.0 months （95%CI： 5.7-8.3）. Among the 7 patients， the APF level decreased in 5 cases. The common treatment-related side effects included hypertension， proteinuria， thrombocytopenia and neutropenia，mainly in grade 1-3. Except one patient discontinued apatinib treatment due to grade 3 hypertension，the side effects were controlled and tolerated well in the other patients. Conclusion Apatinib is effective and tolerable in advanced AFP-positive gastric cancer.