Trifluridine/tipiracil (Lonsurf®) is a fixed-dose combination tablet comprising 
trifluridine, an antineoplastic nucleoside analogue, and tipiracil, a thymidine 
phosphorylase inhibitor. Trifluridine/tipiracil has recently been granted an 
additional indication in the USA for the treatment of metastatic gastric cancer, 
including gastroesophageal junction adenocarcinoma, in patients who have been 
previously treated with at least two systemic treatment regimens, and has 
received a positive opinion for this indication in the EU. In the large pivotal 
phase III TAGS trial, trifluridine/tipiracil plus best supportive care (BSC) 
significantly prolonged overall survival (OS; primary endpoint) compared with 
placebo plus BSC in this patient group. Progression-free survival (PFS) and the 
disease control rate were also improved with trifluridine/tipiracil relative to 
placebo. Health-related quality of life was not adversely affected by the 
addition of trifluridine/tipiracil to BSC and time to deterioration of Eastern 
Cooperative Oncology Group (ECOG) performance status was significantly delayed. 
The most common adverse events were mainly haematological (neutropenia, 
leucopenia and anaemia) and gastrointestinal (nausea, vomiting and diarrhoea), 
and were generally manageable with dosage modifications and/or supportive care. 
Adverse events ≥ Grade 3 were most frequently haematological in nature. Thus, 
trifluridine/tipiracil provides a valuable and much needed treatment option for 
patients with metastatic gastric or gastroesophageal junction adenocarcinoma 
that has progressed on at least two prior therapies.