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Standard chemotherapy for metastatic gastric cancer employs first-line fluorinated pyrimidine and a platinum agent, second-line paclitaxel and ramucirumab, and third-line irinotecan. Trastuzumab is added to first-line chemotherapy in HER2-positive disease. For chemotherapy-refractory disease in either PDL-1–positive or microsatellite instability (MSI)–high cancers, pembrolizumab is now also approved. However, beyond these therapy options, there are no other established therapies.
Investigators now report results of an industry-sponsored, international, randomized, placebo-controlled, phase III trial (TAGS) of trifluridine/tipiracil (TAS-102) in 507 patients with chemotherapy-refractory advanced gastric cancer. Patients were randomized 2:1 to…