Trifluridine-tipiracil hydrochloride (Lonsurf®)

Trifluridine-tipiracil hydrochloride (Lonsurf®) is a chemotherapy drug. It is used to treat bowel cancer (colorectal cancer) that has spread to other parts of the body.

This information should ideally be read with our general information about chemotherapy and the type of cancer you have.

Lonsurf may only be available in some situations. Your cancer doctor can tell you if it is appropriate for you. Some people may be given it as part of a clinical trial.

If a drug isn’t available on the NHS, there may be different ways for you to have it. Your cancer doctor can give you advice. We have further information on what to do if a treatment isn’t available.

Lonsurf is given as tablets which you can take at home. Your doctor, nurse or pharmacist will tell you how many of each tablet to take. It may cause side effects. Tell your doctor or nurse straight away if you have a temperature, feel unwell or have severe side effects.

When and how Lonsurf is given

Lonsurf is usually given after other chemotherapy drugs or biological therapies to treat cancer of the bowel have been used. Or it may be given if these other drugs aren’t suitable.

Lonsurf is given as tablets, so you can have it at home. During treatment, you will regularly see a cancer doctor or a specialist nurse. This is who we mean when we mention doctor or nurse 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

You have Lonsurf as tablets which you can take at home. The tablets come in two strengths – 15mg and 20mg. Your doctor, nurse or pharmacist will tell you how many of each tablet to take. Always take Lonsurf exactly as explained. This is important to make sure they work as well as possible for you.

Take your tablets twice a day, in the morning and evening. Swallow them with a glass of water within an hour of eating your morning and evening meals (or after a snack).

  • If you forget to take your tablets, contact your doctor or nurse. Do not take an extra dose.
  • Keep them in the original package at room temperature and away from heat and direct sunlight.
  • Keep this medicine safe and out of the reach of children.
  • Wash your hands after handling the tablets.
  • Return any remaining capsules to the pharmacist if your treatment is stopped.


Your course of chemotherapy

You have Lonsurf as a course of several sessions (cycles) of treatment for as long as it is working well for you. A cycle of Lonsurf lasts 28 days (four weeks). You usually take the tablets for set days on each cycle:

Week 1

  • Days 1 to 5 – take the tablets twice a day.
  • Days 6 to 7 – don’t take the tablets on these days.

Week 2

  • Days 1 to 5 – take the tablets twice a day.
  • Days 6 to 7 – don’t take the tablets on these days.

Weeks 3 and 4

  • Don’t take any tablets during these weeks.


Possible side effects of Lonsurf

We have included the most common side effects of Lonsurf here. We haven’t included all the less common and rarer side effects. You may get some of the side effects we mention, but you will not get them all.

Always tell your doctor or nurse about the side effects you have. Your doctor can prescribe drugs to help control some side effects or they may adjust the dose of Lonsurf.

It is very important to take them exactly as your nurse or pharmacist has explained. This means they will be more likely to work better for you. Your nurse will give you advice about managing your side effects. When your treatment has finished, the side effects will start to improve.

Serious and life-threatening side effects

Sometimes cancer drugs can result in very serious side effects which, rarely, may be life-threatening. Your cancer doctor and nurse can explain the risk of these side effects to you.

Contact the hospital

Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

More information about side effects

We’re not able to list every side effect for Lonsurf here, particularly the rarer ones. For more detailed information, you can visit the electronic Medicines Compendium (eMC).

Risk of infection

Lonsurf can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low, it’s called neutropenia. Contact the hospital straight away on the number you have been given if:

  • your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4° F), depending on the advice given by your chemotherapy team
  • you suddenly feel unwell, even with a normal temperature
  • you have symptoms of an infection – these can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.

The number of white blood cells usually increases steadily and returns to normal before your next treatment. You will have a blood test before having more chemotherapy. If your white blood cell numbers are still low, your doctor may delay your treatment for a short time.

Bruising and bleeding

Lonsurf can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. If you have any bruising or bleeding you can’t explain, tell your doctor. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin. Some people may need a drip to give them extra platelets.

Anaemia (low number of red blood cells)

Lonsurf can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells (blood transfusion).

Tiredness

Feeling very tired or weak is a common side effect of Lonsurf. You may find it harder to do everyday tasks. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, do not drive or operate machinery.

Feeling sick

Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains to you. It is easier to prevent sickness than to treat it after it has started.

If you still feel sick or are vomiting, contact the hospital as soon as possible. They can give you advice and change the anti-sickness drug to one that works better for you.

Loss of appetite

You may lose your appetite during your treatment. Try to eat small meals regularly. Don’t worry if you don’t eat much for a day or two but try to keep drinking. If your appetite doesn’t improve after a few days, tell your nurse or dietitian. They can give you advice on getting more calories and protein in your diet. They may give you food supplements or meal replacement drinks to try. Your doctor can prescribe them. You can also buy them from chemists.

Diarrhoea

Your doctor can prescribe anti-diarrhoea drugs to control this. You may be given these before you leave hospital. It is important to take them exactly as your nurse or pharmacist explains. If you have diarrhoea, drink at least two litres (three and a half pints) of fluids every day or follow the advice given by your doctor.

If you have diarrhoea at night, or more than 4 to 6 times a day, contact the hospital straight away on the number the nurse gave you. Your doctor may ask you to stop taking Lonsurf. When the diarrhoea is better, they will tell you whether you can start taking it again. Sometimes they reduce the dose.

Difficulty sleeping

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.

Dry or itchy skin

You may notice that your skin becomes more dry. This can be treated with moisturising creams. Your skin may also feel itchy. This can be helped with anti-histamine tablets. Tell your cancer doctor or nurse if you have either of these and they can advise on the best medications for you.


Less common side effects of Lonsurf

Sore mouth

Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth or dentures in the morning, at night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It is important to follow any advice you are given and to drink plenty of fluids.

If you have any problems with your mouth, tell your nurse or doctor. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.

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 bad 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.

Tummy pain

You may get pain or discomfort in your tummy (abdomen). Your doctor can prescribe drugs to help improve these symptoms. Tell them if the pain doesn’t improve or if it gets worse.

Breathlessness

You may feel short of breath after taking Lonsurf. Tell your doctor if this happens or if any existing breathing problems get worse.

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 can give you advice and 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. Tell your nurse about any changes in your hands or feet.

Hair loss

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.


Other information about Lonsurf

Lactose

If you have a severe intolerance to lactose, tell your cancer doctor before taking Lonsurf.

Blood clot risk

Cancer increases the chance of a blood clot (thrombosis) and chemotherapy can further increase this risk. A clot can cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain. If you have any of these symptoms, contact your doctor straight away. A blood clot is serious, but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.

Heart problems

In a small number of people, Lonsurf can affect the heart. If you have chest pain or chest tightness, or if your heartbeat becomes less regular or feels too fast or too slow, contact a doctor straight away.

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.

Other medicines

Some medicines can be harmful to take when you are having Lonsurf. This includes some medicines you can buy in a shop or chemist. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs. Lonsurf can affect how well some drugs used to treat HIV work. Tell your doctor if you are taking zidovudine or any drug like it.

Fertility

Doctors do not know if Lonsurf can affect your fertility (being able to get pregnant or father a child). If you are worried about this, talk to your doctor or nurse before treatment starts.

Contraception

Your doctor will advise you not to become pregnant or father a child while taking Lonsurf. This is because the drugs may harm a developing baby. It is important to use contraception during chemotherapy and for six months after. You can discuss this with your doctor or specialist nurse.

Lonsurf may make the contraceptive pill less effective. So it’s usually best to use ‘barrier’ methods of contraception during treatment. For example, condoms or the cap.

Sex

If you have sex during the course of your chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluid.

Breastfeeding

Women are advised not to breastfeed during treatment and for a few months after. This is in case there is chemotherapy in the breast milk.

Medical and dental treatment

If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are taking Lonsurf. Tell them the name of your cancer doctor so they can ask for advice. Always tell your dentist you are taking Lonsurf.