 Gastric cancer is the third leading cause of cancer-related mortality worldwide. Treatment of metastatic gastric cancer typically aims to prolong overall survival and maximize health-related quality of life. For patients who have failed previous gastric cancer treatments, the oral, fixed-dose tablet trifluoridin tipiracil appears to do just that. Adding tipiracil slows trifluoridin metabolism, boosting the anti-cancer effect at a manageable level of drug toxicity by increasing trifluoridin bioavailability in the body. Once inside the cancer cell, trifluoridin inhibits cell proliferation by interfering with DNA synthesis. The Pivotal Phase 3 Tax Trial examines trifluoridin tipiracil's efficacy and tolerability in previously treated patients with metastatic gastric cancer or adenocarcinoma of the gastroesophageal junction. Data showed that in these patients, trifluoridin tipiracil plus best supportive care significantly prolonged overall survival and progression-free survival compared with placebo plus best supportive care and improved the disease control rate, which is the proportion of patients with either a complete response, a partial response, or stable disease. For a long survival with trifluoridin tipiracil occurred, irrespective of baseline patient and disease characteristics, including prior gastrectomy. Adding trifluoridin tipiracil to best supportive care did not adverse the effect health-related quality of life, and when change in ECOC performance status was evaluated, the time-to-deterioration of patients' ability to care for themselves and to participate in daily activities was significantly delayed in trifluoridin tipiracil recipients. The most common adverse effects with trifluoridin tipiracil were either hematological, such as neutropenia, anemia, and leukopenia, or gastrointestinal, including nausea, vomiting, and diarrhea. These were generally manageable with dose modifications and supportive treatment. All together, the Phase 3 TAGS trial results suggest that trifluoridin tipiracil is an effective and much-needed treatment option for patients with metastatic gastric cancer or gastroesophageal junction adenocarcinoma previously treated with at least two prior systemic therapies.