Trifluridine-tipiracil hydrochloride (Lonsurf®)

Trifluridine-tipiracil hydrochloride (Lonsurf®) is a chemotherapy drug. It is used to treat bowel or stomach cancers that have spread to other parts of the body. 

What is Lonsurf?

Trifluridine-tipiracil hydrochloride (Lonsurf®) is used to treat bowel cancer, stomach cancer and cancer where the oesophagus (food pipe) joins the stomach (gastro-oesophageal junction). It is used if these cancers have spread to other parts of the body (are metastatic).

It may sometimes be used to treat other cancers.

It is best to read this information about with our general information about chemotherapy and the type of cancer you have.

Your cancer doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.

More information about this treatment

This information is correct at time of publishing. But sometimes the types of cancer this treatment is used for, or treatment side effects, may change between revision dates.

You can talk to your cancer team if you want more detailed information about this treatment. Or visit the electronic Medicines Compendium (eMC) website, which has patient information leaflets (PIL) for individual drugs.

How Lonsurf is given

Lonsurf comes in tablets. This means you can take it at home. You may have it with other cancer drugs. 

During your course of treatment, you will meet with someone from your cancer team, such as 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. 

During your course of treatment, you will have regular blood tests. This is to check that it is safe for you to have chemotherapy.  

You will meet with a doctor, nurse or pharmacist before you have chemotherapy. They will talk to you about your blood results and ask how you have been feeling. If your blood results are okay, the pharmacist team will prepare your chemotherapy.

Your course of chemotherapy

You have Lonsurf as cycles of treatment. A cycle lasts 28 days (4 weeks). You usually take the tablets on set days during each cycle:

  • Weeks 1 and 2 – you take Lonsurf tablets twice a day for 5 days. This means you take them on days 1 to 5 and days 8 to 12.
  • Weeks 3 and 4 – you do not take any Lonsurf tablets.

You take Lonsurf for as long as it is helping you and you are coping with the side effects. Your cancer team will discuss your treatment plan with you. They may give you a copy of the treatment plan to take home.

Your cancer team will give you the tablets to take home. Always take them exactly as explained. This is important to make sure they work as well as possible for you.

You may be given tablets of different strengths. Lonsurf tablets come in 2 strengths:

  • 15mg tablets
  • 20mg tablets.

The dose of Lonsurf may change each cycle. This may be because of side effects or changes to your weight. It is very important that you know how many tablets to take each time you start a new cycle.

Your cancer team may also give you anti-sickness drugs and other medicines to take home. Take all your tablets exactly as they tell you to.

Taking Lonsurf tablets

Swallow Lonsurf tablets whole with a glass of water. Do not chew, open or crush them. Take them within 1 hour after eating your morning and evening meals.

If you forget to take the tablets, do not take a double dose. Contact the hospital on the 24-hour number you have been given for advice.

Other things to remember about your tablets:

  • Wash your hands after taking them.
  • Other people should avoid direct contact with them.
  • Keep them in the original package and at room temperature, away from heat and direct sunlight.
  • Keep them safe and out of sight and reach of children.
  • If you are sick just after taking the tablets, contact the hospital. Do not take an extra dose. Take your next dose at the usual time.
  • Do not throw away unused tablets. Return them to your cancer team at the hospital.

About side effects

We explain the most common side effects of this treatment here. We also include some that are less common. 

You may get some of the side effects we mention, but you are unlikely to get all of them. And you may have some side effects, including rarer ones, that we have not listed here. 

Other cancer treatments may cause different side effects. If you are also having other cancer treatment, you may have other side effects.

Always tell your doctor, nurse or pharmacist about any side effects you have. They can give you: 

  • drugs to help control some side effects 
  • advice about managing side effects. 

It is important to take any drugs exactly as explained. This means they will be more likely to work for you.

Serious and life-threatening side effects

Some cancer treatments can cause serious side effects. Sometimes, these may be life-threatening. Your doctor, nurse or pharmacist can explain the risk of these side effects to you.

Contact the hospital

Your doctor, nurse or pharmacist will give you 24-hour contact numbers for the hospital. If you feel unwell or need advice, you can call at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

Common side effects

Risk of infection

This treatment can reduce the number of white blood cells in your blood. These cells fight infection. If your white blood cell count is low, you may be more likely to get an infection. A low white blood cell count is 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. If you have any of the following symptoms, contact the hospital straight away on the 24-hour number:

  • a temperature above 37.5°C 
  • a temperature below 36°C
  • you feel unwell, even with a normal temperature
  • you have symptoms of an infection.

Symptoms of an infection include:

  • feeling shivery and shaking
  • a sore throat
  • a cough
  • breathlessness
  • diarrhoea
  • needing to pass urine (pee) often, or discomfort when you pass urine.

It is important to follow any specific advice your cancer treatment team gives you.

You will have regular blood tests during treatment. If your white blood cell count is low, your doctor may stop your treatment for a short time, until your cell count increases. Sometimes they will reduce the dose of your treatment.

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:

  • nosebleeds
  • bleeding gums
  • heavy periods
  • blood in your urine (pee) or stools (poo)
  • tiny red, brown or purple spots that may look like a rash – these spots can be harder to see if you have black or brown skin. 

If you have any unexplained bruising or bleeding, contact the hospital straight away on the 24-hour number. 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 feel:

  • very low in energy
  • breathless 
  • dizzy and light-headed. 

If you have these symptoms, contact the hospital straight away on the 24-hour number. You may need treatment for anaemia. 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

Feeling tired is a common side effect of this treatment. 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.

Feeling sick

Your doctor, nurse or pharmacist will prescribe anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as they tell you to, even if you do not feel sick. It is easier to prevent sickness than to treat it after it has started.

If you feel sick, take small sips of fluid often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, or if you are sick (vomit) 1 to 2 times in 24 hours, contact the hospital on the 24-hour number as soon as possible. They will give you advice. They may change your anti-sickness treatment. Let them know if you still feel sick.

Loss of appetite

This treatment can affect your appetite. Don’t worry if you do not eat much for 1 or 2 days. But if your appetite does not come back after a few days, or if you are losing weight, tell your doctor, nurse or pharmacist. They can give you advice. They may give you food or drink supplements. Or they may suggest changes to your diet or eating habits to help.

Diarrhoea

This treatment may cause severe diarrhoea. Diarrhoea means passing more stools (poo) than is normal for you, or having watery or loose stools. If you have a stoma, it will be more active than usual. 

Your doctor, nurse or pharmacist may give you anti-diarrhoea drugs to take at home. 

If you have diarrhoea or a mild increase in stoma activity, follow their advice about: 

  • taking anti-diarrhoea drugs 
  • how much and what type of fluids to drink 
  • any changes to your diet that might help. 

Contact the hospital straight away on the 24-hour number if:

  • you have diarrhoea at night 
  • you have uncomfortable stomach cramps
  • you have diarrhoea 4 or more times in a day 
  • you have a moderate increase in stoma activity 
  • the anti-diarrhoea drugs do not work within 24 hours.

You may need to give a stool sample, or go to hospital to have fluids through a drip or antibiotics.

Constipation

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 on the 24-hour number for advice. They can give you drugs called laxatives to help. 

If you have not been able to pass stools for over 2 days and are being sick, contact the 24-hour number straight away. 

Skin changes

Chemotherapy can affect your skin. If your skin feels dry, try using soap-free cleansers and unperfumed moisturising cream every day.

This treatment can also:

  • cause a rash, which may be itchy 
  • make your skin darker in some areas 
  • make any area treated with radiotherapy become red or sore. If you have white skin the area will become red and if you have black or brown skin the area might become darker. 
  • make you more sensitive to the sun. 

Your skin may burn more easily during treatment and for several months after. Use a sun cream of at least SPF 30. SPF stands for sun protection factor. Cover up with clothing and wear a hat. 

Always tell your doctor, nurse or pharmacist about any skin changes. They can give you advice or prescribe creams or medicines to help. Changes to your skin are usually temporary and improve when treatment ends.

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.

Contact the hospital straight away on the 24-hour number, if:

  • a sore mouth or throat affects how much you can drink or eat 
  • your mouth, tongue, throat or lips have any blisters, ulcers or white patches. 

They can give you advice, and mouthwash or medicines to help with the pain or to treat any infection. Follow their advice and make sure you:

  • drink plenty of fluids
  • avoid alcohol and tobacco
  • avoid food or drinks that irritate your mouth and throat.

Changes to your taste

Some foods may taste different or have no taste. Try different foods to find out what tastes best to you. You may also get a bitter or metallic taste in your mouth. Your doctor, nurse or pharmacist can give you advice. It might help to try:

  • sucking sugar-free sour or boiled sweets
  • eating cold foods
  • eating sharp-tasting fresh fruit.

Taste changes usually get better after treatment ends. We have more information about coping with changes to taste.

Tummy pain

You may:

  • get pain or discomfort in your tummy
  • 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:  

  • breathlessness 
  • a cough 
  • wheezing 
  • a fever, with a temperature over 37.5 C (99.5F). 

You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs. This may be treated with steroids or other treatments.  

Fluid build-up (oedema)

Sometimes fluid builds up in the legs and ankles. This is called oedema. Fluid may also build up in the linings of the lungs. This is called a pleural effusion.

Oedema and pleural effusion may be treated with drugs that help you to you pass more urine (pee). 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.

Hair loss

It is not common to lose your hair when taking Lonsurf. Any hair loss is almost always temporary. Your nurse can talk to you about ways to cope with hair loss.

Less common side effects

Hand-foot (palmar-plantar) syndrome

This treatment can affect the palms of your hands and the soles of your feet. This is called palmar-plantar or hand-foot syndrome. 

If you have white skin these areas may become red. If you have black or brown skin, these areas might get darker. 

The skin on the palms of your hands and the soles of your feet may:

  • be sore
  • be painful, tingle, or swell
  • peel, crack or blister. 

If you have any of these symptoms, contact the hospital straight away on the 24-hour number. They can give you advice. This is especially important if you have any broken skin or if walking is difficult. They can prescribe creams and painkillers to help.

You can care for your hands and feet by: 

  • keeping your hands and feet cool by washing in cool water
  • gently moisturising your hands and feet regularly
  • wearing gloves to protect your hands and nails when working in the house or garden
  • wearing loose cotton socks and avoiding tight-fitting shoes and gloves.

Numb or tingling hands or feet (peripheral neuropathy)

This treatment may affect the nerves in your fingers and toes. This can cause numbness, tingling or pain in your hands or feet. This is called peripheral neuropathy. You might find it hard to do fiddly tasks such as fastening buttons or tying shoelaces.

If you have these symptoms, always tell your doctor, nurse or pharmacist. They sometimes need to change the drug or the dose of the drug. The symptoms usually improve slowly after treatment ends. But for some people they continue and are a long-term side effect of treatment.

Effects on the heart

This treatment can affect how the heart works. You may have tests to check 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 the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:

  • breathlessness
  • dizziness
  • changes to your heartbeat
  • swollen feet and ankles.

Other conditions can cause these symptoms, but it is important to get them checked by a doctor. 

Always call 999 if you have:

  • chest pain, pressure, heaviness, tightness or squeezing across the chest
  • difficulty breathing.

Effects on the nervous system

This treatment can make you feel dizzy (vertigo) or faint. Do not drive or operate machinery if you feel dizzy or faint.

This treatment may cause headaches. If this happens, tell your doctor or nurse. They can give you painkillers. You may also feel anxious or have difficulty sleeping. Your doctor or nurse can give you advice about how to manage these side effects.

Effects on the liver and kidneys

This treatment can affect how your kidneys or liver work. This is usually mild and goes back to normal after treatment ends. You will have blood tests to check how well your kidneys and liver are working. Contact the hospital on the 24-hour number if you:

  • have blood in your urine (pee)
  • are passing less urine or peeing less often than usual.

Drinking fluids also helps protect your kidneys. The advice is usually to try to drink at least 2 litres (3½ pints) of fluid each day. But follow any advice from your doctor, nurse or pharmacist about how much is right for you.

Problems passing urine

Lonsurf may cause problems with passing urine (pee). Tell your doctor or nurse straight away if you notice blood in your pee or if you have pain or difficulty peeing.

Eye problems

This treatment may give you dry eyes. Or it may make your eyes feel sore, look red and feel itchy. This is called conjunctivitis. Your doctor may prescribe eye drops to help prevent eye problems. It is important to use these as explained.

You may notice changes in your eyesight. Always tell your doctor or nurse if you have eye pain or notice any change with eyes or your eyesight. It is important not to drive or operate machinery if you notice these effects.

Muscle or joint pain

You may get pain in your muscles or joints for a few days after treatment. If this happens, tell your doctor, nurse or pharmacist. They can give you painkillers and advice. They can also tell you if any of the painkillers you usually take are suitable. 

Tell them if the pain does not get better. Having warm baths and resting regularly may help. 

Other important information

Lactose

This treatment may contain lactose. If you have a lactose allergy or intolerance, ask your doctor, nurse or pharmacist for more information.

Blood clot risk

Cancer and some cancer treatments can increase the risk of a blood clot. Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:

  • throbbing pain or swelling in a leg or arm
  • reddening of the skin in the area – if you have black or brown skin, this can be harder to notice, but the skin might become darker
  • suddenly feeling breathless or coughing.

Always call 999 if you have:

  • chest pain
  • difficulty breathing.

A blood clot is serious, but it can be treated with drugs called anticoagulants. These thin the blood. Your doctor, nurse or pharmacist can give you more information about preventing and treating blood clots.

Other medicines

Some medicines can affect how this treatment works or be harmful while you are having it. Always tell your cancer doctor, nurse or pharmacist about any drugs you are taking or planning to take, such as: 

Vaccinations

Doctors usually recommend that people with cancer have vaccinations for flu and for coronavirus (covid). These help reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems.

If your immune system is weak, you should not have live vaccinations. Live vaccines can make you unwell because they contain a very weak version of the illness they will protect you against. Live vaccines include Zostavax®, which is a shingles vaccine, and the yellow fever vaccine.

It is important to ask your doctor, nurse or pharmacist for advice about having vaccinations. They can explain what vaccines are right for you and when it is best to have them.

Contraception

Your doctor, nurse or pharmacist will advise you not to get pregnant or make someone pregnant while having this treatment and for some time afterwards. The drugs may harm a developing baby. It is important to use contraception to prevent pregnancy. Follow their advice about:

  • what types of contraception to use 
  • how long after treatment you should continue to use contraception. 

Breastfeeding

You are advised not to breastfeed while having this treatment, or for some time after treatment ends. This is because the drugs could be passed to the baby through breast milk. 

Your doctor, nurse or pharmacist can give you more information.

Fertility

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

Sex

It is possible that small amounts of chemotherapy may be passed on through vaginal fluids or semen. If you have sex during this treatment, your cancer team will usually advise using condoms or a dental dam to protect your partner.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the healthcare professional that you are having cancer treatment. Give them the contact details for your cancer doctor or cancer team so they can ask for advice.

If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to your cancer team before you have any dental treatment.

About our information

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert health professionals and people living with cancer.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

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  • use illustrations to explain text
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We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.

Date reviewed

Reviewed: 01 May 2024
|
Next review: 01 May 2026
Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

Our cancer information meets the PIF TICK quality mark.

This means it is easy to use, up-to-date and based on the latest evidence. Learn more about how we produce our information.