TM Owner Taiho Pharma
Lonsurf 15mg + 6.14mg Tablet
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Indications & Clinical Uses
- Lonsurf 15 mg/6.14 mg film-coated tablets contain trifluridine, a nucleoside metabolic inhibitor, with tipiracil, a thymidine phosphorylase inhibitor that stops trifluridine being broken down before it reaches the tumour.
- Lonsurf is approved for adults with metastatic colorectal cancer, alone or combined with bevacizumab, who have already received fluoropyrimidine, oxaliplatin and irinotecan chemotherapy, an anti-VEGF medicine and, where the tumour is RAS wild-type, an anti-EGFR medicine.
- It is also approved for adults with metastatic gastric or gastro-oesophageal junction adenocarcinoma after at least two prior lines of chemotherapy.
- A higher-strength 20 mg/8.19 mg tablet also exists and dosing is based on body surface area, so both strengths are often dispensed together.
- The EU authorisation dates from 25 April 2016 and is held by Les Laboratoires Servier; the US label is held by Taiho Oncology.
Side Effects
- Lonsurf has no boxed warning, but severe myelosuppression is its main risk.
- Used alone, the commonest reactions were tiredness (52 percent), nausea (48 percent), reduced appetite (39 percent), low neutrophils (38 percent), diarrhoea (32 percent), vomiting (28 percent), abdominal pain (21 percent), fever (19 percent) and anaemia (17 percent).
- Combined with bevacizumab the blood effects are heavier: anaemia 68 percent, low platelets 54 percent and low neutrophils 52 percent.
- Low neutrophils can lead to serious infection.
- Contact your healthcare team urgently if you develop a temperature of 38 degrees Celsius or above, chills, sore throat, mouth ulcers, unusual bruising or bleeding, black stools, severe or bloody diarrhoea, or breathlessness with marked tiredness.
Precautions & Warnings
- Full blood counts are taken before each cycle of Lonsurf and again on day 15, and treatment is withheld if neutrophils fall below 500 per cubic millimetre or platelets below 50,000, or for grade 3 to 4 non-blood toxicity; the dose is then reduced when treatment restarts, with a maximum of three reductions.
- Dose reduction is needed in moderate renal impairment, and Lonsurf is not recommended in severe renal impairment or in moderate to severe hepatic impairment.
- It can harm an unborn baby, so women who could become pregnant must use effective contraception during treatment and for at least 6 months after the last dose, men should use condoms during treatment and for at least 3 months after, and breastfeeding must stop.
- Anyone else handling the tablets should wear gloves and wash their hands afterwards.
- Store at 20 to 25 degrees Celsius.
Avoid Interactions
- No foods or drinks are forbidden with Lonsurf, but the tablets must be taken within 1 hour of finishing your morning and evening meals, because taking them on an empty stomach changes how much drug is absorbed.
- Trifluridine is broken down by thymidine phosphorylase, so other nucleoside analogues such as zidovudine and medicines that interact with this enzyme may alter its effect; tell your healthcare provider if you take antiviral nucleosides.
- Combining Lonsurf with other myelosuppressive chemotherapy, with bevacizumab or with radiotherapy increases the risk of low blood counts and infection, so counts must be watched closely.
- Live vaccines should be avoided while blood counts are low.
- Tell your healthcare provider about all prescription medicines, over-the-counter products, herbal remedies and supplements before each cycle.
References
Frequently Asked Questions
Lonsurf (trifluridine and tipiracil) treats adults with metastatic colorectal cancer, alone or with bevacizumab, after earlier chemotherapy and targeted treatment. It is also used for metastatic stomach or gastro-oesophageal junction cancer after at least two previous chemotherapy lines. It is taken as tablets at home.
Take Lonsurf (trifluridine and tipiracil) twice daily within 1 hour of finishing your morning and evening meals, on days 1 to 5 and days 8 to 12 of each 28-day cycle. The dose is 35 mg/m2 based on body size. Swallow the tablets whole with water.
The most common Lonsurf (trifluridine and tipiracil) side effects are tiredness, nausea, poor appetite, low neutrophils, diarrhoea, vomiting, tummy pain, fever and anaemia. Severe myelosuppression is the main risk, so contact your team urgently for a temperature of 38°C or above, chills or unusual bleeding.
Do not take Lonsurf (trifluridine and tipiracil) on an empty stomach; always take it within 1 hour of finishing a meal. Avoid live vaccines and contact with people who have infections while your counts are low. Anyone else handling your tablets should wear gloves and wash their hands.
Full blood counts are taken before every Lonsurf (trifluridine and tipiracil) cycle and again on day 15. Treatment is paused if neutrophils fall below 500 per cubic millimetre or platelets below 50,000, and the dose is lowered when it restarts. Kidney and liver function are also checked.
Skip the missed Lonsurf (trifluridine and tipiracil) dose and take the next one at its usual time. Never take extra tablets to catch up or two doses at once, and do not replace a dose you have vomited. Tell your healthcare team about missed doses at your next visit.
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