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
What are the side effects of Lonsurf (trifluridine / tipiracil)?
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%)
Other Side Effects
- Fever
- Infections
Serious Side Effects
- Low blood cell counts: fever, chills, feeling very tired, unusual bleeding or bruising
Source: DailyMed
The following 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.
Frequently asked questions about Lonsurf (trifluridine / tipiracil)
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What are the 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 forms
Typical dosing 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
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References
Best studies we foundAjani, J. A., et al. (2023). Esophageal and esophagogastric junction cancers, version 2.2023, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network.
American Cancer Society. (2019). Chemotherapy safety.
American Cancer Society. (2019). Getting oral or topical chemotherapy.
American Cancer Society. (2019). How chemotherapy drugs work.
American Cancer Society. (2024). Neutropenia (low white blood cell counts).
American Cancer Society. (2024). Thrombocytopenia (low platelet count).
Chakrabarti, S., et al. (2021). TAS-102: A resurrected novel fluoropyrimidine with expanding role in the treatment of gastrointestinal malignancies. Pharmacology & Therapeutics.
National Comprehensive Cancer Network. (2023). Stomach cancer.
National Comprehensive Cancer Network. (2024). Colon cancer.
National Comprehensive Cancer Network. (2024). Esophageal cancer.
National Comprehensive Cancer Network. (2024). Rectal cancer.
Taiho Oncology, Inc. (2024). How to take Lonsurf.
Taiho Pharmaceutical Co., Ltd. (2023). Lonsurf- trifluridine and tipiracil tablet, film coated [package insert]. DailyMed.
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