Titanium (Ti)-based metallic biomaterials (MBs) are traditionally employed as mechanical supports and constraints in clinical practice, owing to their superb comprehensive mechanical properties, great corrosion resistance, and good biocompatibility. Recently, Ti-based MBs have emerged as promising candidates for antitumor applications. These developments focus on the functionalization of Ti-based MBs to inhibit tumor propagation and recurrence. This work systematically examines the antitumor approaches of Ti-based MBs and categorizes them into physical and chemical approaches. Physical strategies, such as the photothermal and photocatalytic techniques, are usually related to material-specific properties. Chemical approaches often employ controlled local drug delivery (LDD) systems. Ti-based LDD systems enable the targeted release of chemotherapeutics, metal ions, or immunomodulatory agents at tumor sites. This review highlights the efficacy of these surface-functionalized Ti-based MBs against diverse tumors. Additionally, the challenges and prospects of antitumor Ti-based MBs are also discussed.