Trifluridine-tipiracil hydrochloride (Lonsurf®)
Trifluridine-tipiracil hydrochloride (Lonsurf®) is used to treat bowel cancer, and stomach cancer that has spread to other parts of the body.
Lonsurf is used to treat:
- bowel (colorectal) cancer
- stomach cancer
- cancer where the oesophagus (gullet) joins the stomach (gastro-oesophageal junction).
It is used when these cancers have spread to other parts of the body.
Lonsurf may sometimes be used to treat other cancers. It is best to read this information with our general information about chemotherapy and the type of cancer you have.
Lonsurf contains two active ingredients:
- Trifluridine stops the growth of cancer cells.
- Tipiracil stops trifluridine from being broken down by the body. This helps the trifluridine to work for longer.
Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
Lonsurf is given as tablets, so you can have it at home. During treatment you usually see a:
- cancer doctor
- chemotherapy nurse or specialist nurse
- specialist pharmacist.
This is who we mean when we mention doctor, nurse or pharmacist in this information.
Before or on the day of treatment, a nurse or a person trained to take blood (phlebotomist) will take a blood sample from you. You will also see a doctor or nurse before you have chemotherapy. They will ask you how you have been feeling. This is to check that it is okay for you to have chemotherapy.
Taking Lonsurf tablets
Lonsurf is given as 15mg and 20mg tablets. Your doctor, nurse or pharmacist will tell you how many of each tablet to take. They may give you a copy of the treatment plan to take home with you. Always take Lonsurf exactly as explained. This is important to make sure it works as well as possible for you.
Take your tablets twice a day, in the morning and evening. Take them within an hour of eating your morning and evening meals (or after a snack). Swallow them with a glass of water.
Here are some important things to remember about taking your Lonsurf tablets:
- Wash your hands after taking them.
- Other people should avoid direct contact with your chemotherapy drugs.
- Keep them in the original package at room temperature and away from heat and direct sunlight.
- Keep them out of sight and reach of children.
- If you forget to take your tablets, contact your doctor or nurse. Do not take an extra dose.
- If you are sick soon after taking your tablets, contact the hospital. Do not take another dose.
- If your treatment is stopped, return any unused tablets to the pharmacist.
Your course of chemotherapy
You have Lonsurf as a course of several sessions of treatment for as long as you need it. These sessions are called cycles of treatment. A cycle of Lonsurf lasts 28 days (4 weeks). You usually take the tablets for set days on each cycle.
A cycle may happen like this:
Weeks 1 and 2
- Days 1 to 5: Take the tablets twice a day.
- Days 6 and 7: Do not take the tablets on these days.
Weeks 3 and 4
- Do not take the tablets during these weeks.
We explain the most common side effects of this treatment here. We also include some less common side effects.
You may get some of the side effects we mention, but you are unlikely to get all of them. If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.
Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.
Serious and life-threatening side effects
Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.
Risk of infection
This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If the number of white blood cells is low, you are more likely to get an infection. A low white blood cell count is sometimes called neutropenia.
An infection can be very serious when the number of white blood cells is low. It is important to get any infection treated as soon as possible. Contact the hospital straight away on the 24-hour contact number you have been given if:
- your temperature goes over 37.5°C (99.5°F)
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection
- your temperature goes below 36°C (96.8°F).
Symptoms of an infection include:
- feeling shivery and shaking
- a sore throat
- a cough
- needing to pass urine (pee) a lot, or discomfort when you pass urine.
It is important to follow any specific advice your cancer treatment team gives you.
The number of white blood cells will usually return to normal before your next treatment. You will have a blood test before having more treatment. If your white blood cell count is low, your doctor may delay your treatment for a short time, until your cell count increases.
Bruising and bleeding
This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot.
If the number of platelets is low, you may bruise or bleed easily. You may have:
- bleeding gums
- heavy periods
- blood in your urine (pee) or stools (poo)
- tiny red or purple spots on the skin that may look like a rash.
Tell your doctor if you have any unexplained bruising or bleeding. You may need a drip to give you extra platelets. This is called a platelet transfusion.
Anaemia (low number of red blood cells)
This treatment can reduce the number of red blood cells in your blood. Red blood cells carry oxygen around the body. If the number of red blood cells is low, this is called anaemia. You may have symptoms such as:
- pale skin
- lack of energy
- feeling breathless
- feeling dizzy and light-headed.
Tell your doctor or nurse if you have these symptoms.
If you are very anaemic, you may need a drip to give you extra red blood cells. This is called a blood transfusion.
Feeling tired is a common side effect of this treatment. It is often worse towards the end of treatment and for some weeks after it has finished. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can give you more energy.
If you feel sleepy, do not drive or use machinery.
Your doctor will give you anti-sickness drugs to help prevent or control sickness during your treatment. Take the drugs exactly as your nurse or pharmacist tells you. It is easier to prevent sickness than to treat it after it has started.If you feel sick, take small sips of fluids often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, or are sick (vomit) more than once in 24 hours, contact the hospital as soon as possible. They will give you advice. Your doctor or nurse may change the anti-sickness drug to one that works better for you.
Loss of appetite
This treatment can affect your appetite. Do not worry if you do not eat much for a day or two. But if your appetite does not come back after a few days, tell your nurse or dietitian. They will give you advice. They may give you food or drink supplements.
This treatment may cause severe diarrhoea. Diarrhoea means passing more stools (poo) than is usual for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.
Your hospital team may give you anti-diarrhoea drugs to take at home.
If you have diarrhoea or a mild increase in stoma activity:
- follow any advice from your cancer team about taking anti-diarrhoea drugs
- drink at least 2 litres (3½ pints) of fluids each day
- avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.
Contact the hospital straight away if:
- you have diarrhoea at night
- you have diarrhoea more than 4 times in a day
- you have a moderate or severe increase in stoma activity
- the anti-diarrhoea drugs do not work within 24 hours.
You may need to go to hospital to have fluids through a drip.
This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:
- Drink at least 2 litres (3½ pints) of fluids each day.
- Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
- Do regular gentle exercise, like going for short walks.
If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.
Chemotherapy may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. This treatment can cause a rash, which may be itchy.
Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
Sore mouth and throat
This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.
If your mouth or throat is sore:
- tell your nurse or doctor – they can give you a mouthwash or medicines to help
- try to drink plenty of fluids
- avoid alcohol, tobacco, and foods that irritate your mouth and throat.
Sucking ice chips may sometimes help relieve mouth or throat pain. But if you are having radiotherapy to the head or neck, do not suck on ice. It can cause damage.
Changes to your taste
You may get a bitter or metal taste in your mouth. Sucking sugar-free sweets may help with this. Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. Taste changes usually get better after treatment finishes. Your nurse can give you more advice.
Helpful hints to improve taste
- Season food or add spices and herbs to add flavour when cooking.
- Use strong, flavoured sauces or gravies to make food tastier.
- Eat sharp-tasting fresh fruit and juices or try sugar-free sweets to leave a pleasant taste in your mouth.
- Try cold foods as they may have a stronger taste than hot foods.
- get pain or discomfort in your tummy (abdomen)
- feel bloated
- have indigestion or wind.
Your doctor can give you drugs to help improve these symptoms. Tell them if the pain does not improve or if it gets worse.
Effects on the lungs
This treatment can cause changes to the lungs. Contact the hospital straight away if you notice any of these changes during treatment or after it finishes:
- a cough
- a fever, with a temperature over 37.5°C (99.5°F).
You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs. You may need steroids or other treatments.
Build-up of fluid (oedema)
Sometimes fluid can build up in the legs and ankles. This is called oedema. Fluid may also build up in the lining of the lungs. This is known as pleural effusion.
Oedema and pleural effusion may be treated with drugs that make you pass more urine. These drugs are called diuretics. Always tell your doctor if you notice any swelling. It is important to contact your doctor or the hospital straight away if you:
- develop a cough
- have chest pain
- feel more breathless than usual
- gain weight suddenly.
Soreness and redness of palms of hands and soles of feet
This is called palmar-plantar or hand-foot syndrome. It gets better when treatment ends. Your doctor or nurse may prescribe creams to improve the symptoms. It can help to keep your hands and feet cool and to avoid tight-fitting socks, shoes and gloves.
Numb or tingling hands or feet (peripheral neuropathy)
This treatment affects the nerves, which can cause numb, tingling or painful hands or feet. You may find it hard to fasten buttons or do other fiddly tasks.
Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes, but for some people they may never go away. Talk to your doctor if you are worried about this.
It is not common to lose your hair after taking Lonsurf. It is almost always temporary and your hair will grow back after treatment ends. Your nurse can give you advice about coping with hair loss.
Effects on the heart
This treatment can affect how the heart works. You may have tests to see how well your heart is working. These may be done before, during and after treatment.
If the treatment is causing heart problems, your doctor may change the type of treatment you are having.
Contact your doctor straight away on the 24-hour number the hospital has given you if you have any of these symptoms during or after treatment:
- pain or tightness in your chest
- changes to your heartbeat.
Other conditions can cause these symptoms, but it is important to get them checked by a doctor. If you cannot get through to your doctor, call the NHS urgent advice number on 111.
Effects on the nervous system
This treatment can make you feel dizzy (vertigo) or faint. It may make you feel anxious or have difficulty sleeping. If you feel dizzy or faint, do not drive or operate machinery.
If Lonsurf makes it more difficult to sleep, tell your doctor or nurse. They can give you advice on coping with this. Our information about difficulty sleeping may also help.
This treatment may cause headaches. If this happens, tell your doctor or nurse. They can give you painkillers.
Changes in kidneys or liver
In some people, Lonsurf can affect the kidneys or liver. You will have regular blood tests to check how well your kidneys and liver are working. You will also have urine tests to check for protein.
Problems passing urine
Lonsurf may cause problems with passing urine. Tell your doctor or nurse straight away if you notice blood in your pee or if you have pain or difficulty peeing.
This treatment may give you dry eyes or make your eyes feel sore, red and itchy (conjunctivitis). Your doctor may prescribe eye drops to help prevent this. It is important to use these as instructed. You may notice changes in your vision.
Always tell your doctor or nurse if you have pain or notice any change in your vision. It is important not to drive or operate machinery if you notice these effects.
If you have a severe intolerance to lactose, tell your cancer doctor before taking Lonsurf.
Blood clot risk
Cancer and some cancer treatments can increase the risk of a blood clot. Symptoms of a blood clot include:
- throbbing pain, redness or swelling in a leg or arm
- suddenly feeling breathless or coughing
- sharp chest pain, which may be worse when you cough or take a deep breath.
If you have any of these symptoms, contact the hospital straight away on the 24-hour contact number you have been given. If you cannot get through to your doctor, call the NHS urgent advice number on 111.
A blood clot is serious, but it can be treated with drugs that thin the blood (anticoagulants). Your doctor or nurse can give you more information.You can help reduce the risk of developing a blood clot by:
- staying active during treatment
- drinking plenty of fluids, especially water.
You may be given anticoagulants to help prevent a clot.
Some medicines can affect how this treatment works or be harmful when you are having it. Always tell your cancer doctor about any drugs you are taking or planning to take, such as:
- medicines you have been prescribed
- medicines you buy in a shop or chemist
- vitamins, herbal drugs and complementary therapies.
Tell other doctors, pharmacists or dentists who prescribe or give you medicines that you are having this cancer treatment.
You can visit the electronic Medicines Compendium (eMC) for more detailed information about your treatment.
Vaccinations can reduce your risk of getting certain infections. Your doctor or nurse may talk to you about having vaccinations.
Doctors usually recommend that people with cancer have a flu vaccination and a coronavirus vaccination. These are both inactivated vaccinations that can help reduce the risk of infection. People with weak immune systems can have these, as they are not live vaccinations.
If your immune system is weak, you need to avoid live vaccinations. This is because they can make you unwell. Live vaccines, such as shingles, contain a very weak version of the illness they are vaccinating you against. Your cancer doctor or GP can tell you more about live and inactivated vaccinations.
Your doctor will advise you not to get pregnant or make someone pregnant while taking Lonsurf. The drugs may harm a developing baby. It is important to use contraception during your treatment and for 6 months after treatment finishes. Your doctor, nurse or pharmacist can tell you more about this.
Lonsurf may make hormonal contraceptives less effective. You will need to use a barrier method of contraception such as a condom as well. Your doctor, nurse or pharmacist can tell you more about this.
If you have sex during a course of chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluids.
You are advised not to breastfeed while having this treatment, or for some time after treatment finishes. This is because the drugs could be passed to the baby through breast milk.
Your doctor or nurse can give you more information.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the doctors and nurses you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.
If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.