Drug Action
Trifluridine is an antimetabolite that interferes with cancer cell DNA synthesis and inhibits cell proliferation; tipiracil is a TPase inhibitor that boosts trifluridine concentrations.
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Drug reference
Trifluridine is an antimetabolite that interferes with cancer cell DNA synthesis and inhibits cell proliferation; tipiracil is a TPase inhibitor that boosts trifluridine concentrations.
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Metastatic colorectal cancer, in patients previously treated with (or unsuitable for treatment with) available therapies including fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapies, or anti-vascular endothelial growth factor (VEGF) agents, or anti- epidermal growth factor receptor (EGFR) agents (specialist use only) ▶BY MOUTH ▶Adult: Initially 35 mg/m2 twice daily (max. per dose 80 mg), given on days 1 to 5 and days 8 to 12 of each 28-day cycle, consult product literature for further information on dose adjustment
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NICE decisions ▶Trifluridine with tipiracil for previously treated metastatic colorectal cancer (August 2016) NICE TA405 Trifluridine with tipiracil (Lonsurf ®) is recommended, within its marketing authorisation, as an option for treating metastatic colorectal cancer in adults, only when provided by the manufacturer with the discount agreed in the patient access scheme. www.nice.org.uk/guidance/ta405 Scottish Medicines Consortium (SMC) decisions SMC No. 1221/17 The Scottish Medicines Consortium has advised (February 2017) that trifluridine with tipiracil (Lonsurf ®) is accepted for use within NHS Scotland for the treatment of adults with metastatic colorectal cancer who have been previously treated with, or are not considered candidates for, available therapies including fluoropyrimidine-, oxaliplatin- and irinotecan-based chemotherapies, anti- vascular endothelial growth factor agents, and anti- epidermal growth factor receptor agents. This advice is contingent upon the continuing availability of the Patient Access Scheme in NHS Scotland or a list price that is equivalent or lower.
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RISKS OF INCORRECT DOSING OF ORAL ANTI-CANCER MEDICINES See Cytotoxic drugs p. 938.
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▶Common or very common Alopecia. anaemia. appetite decreased. asthenia. constipation. cough. decreased leucocytes. diarrhoea. dizziness. dyspnoea. fever. flushing. gastrointestinal discomfort. headache. hyperbilirubinaemia. hypoalbuminaemia. increased leucocytes. increased risk of infection. insomnia. malaise . mucositis. nausea. neutropenia. oedema. oral disorders . peripheral neuropathy. skin reactions. taste altered. thrombocytopenia. urine abnormalities. vomiting. weight decreased ▶Uncommon Angina pectoris. anxiety. arrhythmia. ascites. bile duct disorders. cancer pain. cataract. conjunctivitis. cystitis. dehydration. dry eye. dysphonia. ear discomfort. electrolyte imbalance. embolism and thrombosis. erythropenia. feeling of body temperature change. gastrointestinal disorders. gout. haemorrhage. hepatotoxicity. hyperglycaemia. hyperhidrosis. hypertension. hypotension. joint disorders. lethargy. menstrual disorder. muscle complaints. muscle weakness . nail disorder. neurotoxicity. oropharyngeal pain. pain. palpitations. pancreatitis acute. pancytopenia. photosensitivity reaction. pleural effusion. QT interval prolongation. renal failure. rhinorrhoea. sensation abnormal. sensation of pressure. septic shock (including fatal cases). syncope. urinary disorder. vertigo. vision disorders
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Manufacturer advises effective contraception in women of child-bearing potential and in men with a partner of child-bearing potential, during treatment and for 6 months after stopping treatment. Manufacturer also advises use of an additional barrier method in women using hormonal contraceptives—effect of trifluridine with tipiracil on hormonal contraception unknown.
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Manufacturer advises avoid unless Immune system and malignant disease essential—reproductive toxicity in animal studies.
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Manufacturer advises avoid—present in milk in animal studies.
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Manufacturer advises avoid in moderate to severe impairment (limited information available).
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Manufacturer advises caution if eGFR 30–59 mL/minute/1.73 m2—monitor for haematological toxicities; manufacturer advises avoid if eGFR less than 30 mL/minute/ 1.73m2—no information available.
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Manufacturer advises obtain baseline blood cell counts before and during treatment; monitor closely for myelosuppression. Manufacturer also advises monitoring for proteinuria before and during treatment.
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There can be variation in the licensing of different medicines containing the same drug. Tablet CAUTIONARY AND ADVISORY LABELS 21 ▶Lonsurf (Servier Laboratories Ltd) A Tipiracil (as Tipiracil hydrochloride) 6.14 mg,Trifluridine 15 mg Lonsurf 15mg/6.14mg tablets | 20 tablet P £500.00 | 60 tablet P £1,500.00 Tipiracil (as Tipiracil hydrochloride) 8.19 mg,Trifluridine 20 mg Lonsurf 20mg/8.19mg tablets | 20 tablet P £666.67 | 60 tablet P £2,000.00 ANTINEOPLASTIC DRUGS › CYTOTOXIC ANTIBIOTICS AND RELATED SUBSTANCES
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Initially 35 mg/m2 twice daily (max. per dose
First-line fragment. Read the complete Indications and Dose section above.
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