Lonsurf
Lonsurf (trifluridine / tipiracil) is a type of chemotherapy called an antimetabolite. It’s used to treat cancers of the digestive system, such as the stomach and colon, that have spread throughout the body (metastasized). This medication is typically taken after first-choice and second-choice treatments no longer work. Lonsurf (trifluridine / tipiracil) is a tablet that’s taken by mouth twice daily on certain days of each chemotherapy cycle. Common side effects include tiredness and an upset stomach. This medication can also raise your risk for infections.
What is Lonsurf (trifluridine / tipiracil)?
What is Lonsurf (trifluridine / tipiracil) used for?
- Metastatic colon or rectal cancer, taken by itself or together with Avastin (bevacizumab), after previous treatments haven't worked
- Metastatic stomach cancer, after at least two previous treatments haven't worked
- Metastatic esophagus cancer, after at least two previous treatments haven't worked
How Lonsurf (trifluridine / tipiracil) works
Lonsurf (trifluridine / tipiracil) is a combination of two medications that work together to treat your cancer.
- Trifluridine is an antimetabolite. It works against cancer cells by interfering with DNA, the genetic material needed for cells in the body to grow and divide.
- Tipiracil prevents your body from breaking down trifluridine. This allows trifluridine to stay in your body longer to work against the cancer.
Drug facts
Side effects of Lonsurf (trifluridine / tipiracil)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Low blood cell counts (up to 77%)
- Feeling very tired (52%)
- Nausea (48%)
- Low appetite (39%)
- Diarrhea (32%)
- Vomiting (28%)
- Stomach pain (21%)
Less Common Side Effects
- Fever
- Infections
Note: Side effects that are listed were reported by people who took Lonsurf (trifluridine / tipiracil) by itself for metastatic colon cancer during clinical studies. Side effects might differ if you take the medication with other chemotherapy or for other types of cancer.
Lonsurf (trifluridine / tipiracil) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Low blood cell counts: fever, chills, feeling very tired, unusual bleeding or bruising
The following Lonsurf (trifluridine / tipiracil) side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
- Low red blood cell level—unusual weakness or fatigue, dizziness, headache, trouble breathing
- Unusual bruising or bleeding
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
Pros and cons of Lonsurf (trifluridine / tipiracil)
Pros
- A tablet that’s taken by mouth twice a day
- Taken with any type of food in the morning and evening
- A treatment option for metastatic colon, rectal, and stomach cancers and certain esophagus cancers after other preferred treatment regimens no longer work
Cons
- Might need to take more than one tablet for each dose
- Often causes tiredness and nausea
- Can lower blood cell counts and put you at risk for infections
Pharmacist tips for Lonsurf (trifluridine / tipiracil)
- Lonsurf (trifluridine / tipiracil) tablets are available in two different strengths; you can tell them apart by their color (white or pale red). Your oncologist might prescribe both strengths, since it’s possible that you’ll need to combine them to make up your specific dose.
- Swallow Lonsurf (trifluridine / tipiracil) tablets whole after your morning and evening meals. Wash your hands after you take the tablets because cancer medications can be harmful.
- If you vomit or miss your Lonsurf (trifluridine / tipiracil) dose, don’t make up the dose. Instead, take your next dose at the usual time. Don’t “double up” on the dose to make up for the missed dose because this can put you at risk for side effects.
- It’s common for Lonsurf (trifluridine / tipiracil) to cause upset stomach, vomiting, or diarrhea. Tell your treatment team if these side effects begin to interfere with your daily routine or your ability to eat and drink normally. Your care team might be able to recommend supportive medications or treatments to help with your symptoms.
- Be sure to get your scheduled blood tests done on time while you’re taking Lonsurf (trifluridine / tipiracil). The medication can cause low blood cell counts and put you at risk for infections or bleeding. So these blood tests help your oncologist check your blood cell counts to make sure treatment is safe for you. Let your care team know right away if you have a fever, since it could be a sign of infection.
- Store Lonsurf (trifluridine / tipiracil) at room temperature in its original bottle, out of reach from children or pets. If you place the tablets outside of the original bottle (e.g., in a pill box or pill organizer), throw away unused tablets after 30 days. Speak with your treatment team about how to safely get rid of cancer medications because they're harmful to others.
- If you’re able to become pregnant, use effective birth control while you’re taking Lonsurf (trifluridine / tipiracil) and for at least 6 months after your last dose. If you’re male and have a partner who could become pregnant, use condoms during treatment and for 3 months after your last dose. Lonsurf (trifluridine / tipiracil) can harm an unborn baby.
- Avoid breastfeeding while you’re taking Lonsurf (trifluridine / tipiracil) and for at least 1 day after your last dose. We don’t know whether the medication can get into breast milk, but it might harm the breastfeeding infant if it does.
Common questions about Lonsurf (trifluridine / tipiracil)
Yes, Lonsurf (trifluridine / tipiracil) is a type of chemotherapy. Traditional chemotherapy works by attacking all rapidly-dividing cells in the body, including cancer cells. Since chemotherapy like Lonsurf (trifluridine / tipiracil) isn’t specifically targeted toward cancer cells, the medication can cause side effects in other parts of the body with fast-growing cells. For example, Lonsurf (trifluridine / tipiracil) can affect the bone marrow so that it can’t make enough blood cells, leading to low blood cell counts.
Since Lonsurf (trifluridine / tipiracil) is a chemotherapy pill, you should wash your hands after you handle the medication, including after you take each dose. For any caregivers who are helping you with your cancer medications, they should wear gloves when they’re handling Lonsurf (trifluridine / tipiracil) tablets to prevent chemotherapy exposure. Be sure they also wash their hands after they handle the medication. Chemotherapy can be very harmful to others.
It depends on how well Lonsurf (trifluridine / tipiracil) is working against your cancer and how well you’re able to tolerate the medication. In general, your treatment team will follow up with you on your symptoms and scans to see how well Lonsurf (trifluridine / tipiracil) is working for you. Your prescriber might stop the medication and change your treatment plan if your symptoms worsen or if your scans show signs that the cancer is getting worse. Another reason people might stop taking Lonsurf (trifluridine / tipiracil) is if they have side effects, like infections or nausea, that are severe. In studies, fewer than 40% of people who took Lonsurf (trifluridine / tipiracil) for colon, rectal, or stomach cancer were treated for 6 months or longer.
It depends on your specific situation whether Lonsurf (trifluridine / tipiracil) is a last-resort treatment for you. In general, Lonsurf (trifluridine / tipiracil) isn’t a first-choice treatment for colon, rectal, esophagus, or stomach cancer. So when first-choice treatments no longer work, your oncologist might consider other options based on your cancer, your previous treatments, and specific treatment guidelines. These other options could potentially include Lonsurf (trifluridine / tipiracil), other cancer treatments, clinical trials, or other supportive care. Talk with your oncologist about your specific treatment plan.
It’s recommended to take Lonsurf (trifluridine / tipiracil) after your morning and evening meal. This helps make sure that the medication can work at its best to treat your cancer. A study suggested that taking Lonsurf (trifluridine / tipiracil) with food doesn’t affect how well the medication works while possibly lowering the risk for having low white blood cell counts from the medication.
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Risks and warnings for Lonsurf (trifluridine / tipiracil)
Lonsurf (trifluridine / tipiracil) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Severely low blood cell counts (bone marrow suppression)
- Risk factors: Older age
Lonsurf (trifluridine / tipiracil) affects your bone marrow and causes your body to make fewer blood cells. Low amounts of blood cells can make you more likely to develop anemia, bleed more easily, and get infections. Talk to your treatment team right away if you suddenly have unusual bleeding or bruising, muscle weakness, or tiredness or if you develop a fever at any time while you’re taking Lonsurf (trifluridine / tipiracil).
Throughout treatment, you’ll need to get blood tests done so your care team can check your blood cell counts. This helps make sure it’s safe for you to continue taking Lonsurf (trifluridine / tipiracil). Usually, they’ll check your blood cell counts before day 1 and on day 15 of each treatment cycle of Lonsurf (trifluridine / tipiracil).
You might need to stop taking Lonsurf (trifluridine / tipiracil) for a while if your treatment team notices that your blood cell counts are very low. Once your blood cell counts return to a safe level, you’ll probably restart the medication at a lower dose.
Harm to an unborn baby
Based on findings from animal studies and on the way the medication works, it’s possible for Lonsurf (trifluridine / tipiracil) to harm an unborn baby if it’s taken during pregnancy.
You'll need to take a pregnancy test before you start Lonsurf (trifluridine / tipiracil) if you’re able to have children so your oncologist can check that it’s safe to take. To prevent pregnancy, take birth control during treatment and for at least 6 months after your last dose. If you’re male and have partners who could become pregnant, use condoms during treatment and for at least 3 months after your last dose. Let your oncology care team know right away if you become pregnant while you’re taking Lonsurf (trifluridine / tipiracil).
Lonsurf (trifluridine / tipiracil) dosage
Typical dosage for Lonsurf (trifluridine / tipiracil)
Your treatment team will determine your dose based on your body surface area or body size (BSA, in m2 units), which they’ll calculate from your height and weight.
The typical dose is 35 mg/m2 of the trifluridine component of Lonsurf (trifluridine / tipiracil). The medication is available in two strengths: 15 mg of trifluridine with 6.14 mg of tipiracil; and 20 mg of trifluridine with 8.19 of tipiracil.
Each dose is taken by mouth twice a day with food on days 1 through 5 and days 8 through 12 of each 28-day treatment cycle. This means that you’ll take Lonsurf (trifluridine / tipiracil) for 5 days in a row followed by 2 days of rest for the first 2 weeks of a cycle. Then, you’ll take 2 weeks off from the medication before you start the next cycle.
Your treatment team might adjust your Lonsurf (trifluridine / tipiracil) dose based on how well your kidneys are working and whether you have side effects from the medication.
Lonsurf (trifluridine / tipiracil) images
