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Care During Chemotherapy and Beyond

Trifluridine/Tipiricil

Trade Name: Lonsurf®

Trifluridine/tipiricil is the generic name for the trade name drug, Lonsurf. In some cases, health care professionals may use the trade name, Lonsurf, when referring to the generic drug name trifluridine, tipiricil.

Drug Type: Trifluridine/tipiricil is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. This medication is classified as an antimetabolite/pyrimidine analog; antimetabolite/thymidine phosphorylase inhibitor. (For more detail, see "How Trifluidine/tipiricil Works" below)

What Trifluridine/tipiricil Is Used For:

  • Trifluridine/tipiricil is used to treat metastatic colorectal cancer in patients who have been previously been treated with fluoropyrimidine, oxaliplatin, and irinotecan based chemotherapy, an anti-VEGF biological therapy, and an anti-EGFR therapy (if RAS wild type).

Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How Trifluridine/tipiricil Is Given:

  • Trifluridine/tipiricil is tablet that is taken by mouth.
  • Take twice a day within one hour of eating your morning and evening meals.
  • Take with a glass of water.
  • The tablets come in two strengths and you may need to take a combination of the two strengths to get to your specific dose. Follow yours instructions carefully.
  • Trifluridine/tipiricil is usually taken twice a day on days 1 to 5, and days 8 to 12 of a 28 day cycle.

The amount of Trifluridine/tipiricil that you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition you have. Your doctor will determine your exact dosage and schedule.

Side Effects

Important things to remember about the side effects of trifluridine/tipiricil:

  • Most people will not experience all of the trifluridine/tipiricil side effects listed.
  • Trifluridine/tipiricil side effects are often predictable in terms of their onset, duration, and severity.
  • Trifluridine/tipiricil side effects will improve after therapy is complete.
  • Trifluridine/tipiricil side effects may be quite manageable. There are many options to minimize or prevent the side effects of trifluridine/tipiricil.

The following side effects are common (occurring in greater than 30%) for patients taking trifluridine/tipiricil"

These are less common side effects for patients receiving trifluridine/tipiricil"

Not all side effects are listed above. Side effects that are very rare - occurring in less than about 10 percent of patients - are not listed here. But you should always inform your health care provider if you experience any unusual symptoms.

When to Contact Your Healthcare Provider

Contact your health care provider immediately, day or night, if you should experience any of the following symptoms;

  • Fever of 100.5º F (38º C) or higher, chills (possible signs of infection)

The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following:

  • Nausea (interferes with ability to eat and unrelieved with prescribed medication)
  • Vomiting (vomiting more than 4-5 times in a 24 hour period)
  • Diarrhea (4-6 episodes in a 24-hour period)
  • Unusual bleeding or bruising
  • Black or tarry stools, or blood in your stools
  • Blood in the urine
  • Pain or burning with urination
  • Extreme fatigue (unable to carry on self-care activities)
  • Signs of infection such as redness or swelling, pain on swallowing, coughing up mucous, or painful urination.
  • Unable to eat or drink for 24 hours or have signs of dehydration: tiredness, thirst, dry mouth, dark and decrease amount of urine, or dizziness.

Always inform your health care provider if you experience any unusual symptoms.

Precautions

  • Before starting trifluridine/tipiricil treatment, make sure you tell your doctor about any other medications you are taking (including prescriptions, over-the-counter, vitamins, herbal remedies, etc.). Do not take aspirin, products containing aspirin unless your doctor specifically permits this.
  • Do not receive any kind of immunization or vaccination without your doctor's approval while taking trifluridine/tipiricil.
  • Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category X (Trifluridine/tipiricil may cause fetal harm when given to a pregnant woman. This drug must not be given to a pregnant woman or a woman who intends to become pregnant. If a woman becomes pregnant while taking trifluridine/tipiricil, the medication must be stopped immediately and the woman given appropriate counseling).
  • For both men and women: Use contraceptives, and do not conceive a child (get pregnant) while taking trifluridine/tipiricil. Barrier methods of contraception, such as condoms, are recommended. Males, with female partners who may become pregnant, should use condoms during their treatment with trifluridine/tipiricil and for at least 3 months after the last dose.
  • Do not breast feed while taking trifluridine/tipiricil.

Self-Care Tips

  • Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
  • You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider.
  • Wash your hands often.
  • Use an electric razor and a soft toothbrush to minimize bleeding.
  • Avoid contact sports or activities that could cause injury.
  • To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.
  • Follow regimen of anti-diarrhea medication as prescribed by your health care professional.
  • Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.
  • In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
  • Get plenty of rest.
  • Maintain good nutrition.
  • Remain active as you are able. Gentle exercise is encouraged such as a daily walk.
  • If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing While Taking Trifluridine/tipiricil

You will be checked regularly by your doctor while you are taking trifluridine/tipiricil, to monitor side effects and check your response to therapy. Periodic blood work will be obtained to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.

How Trifluridine/tipiricil Works

Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition. Cancerous cells lose this ability. Cancer cells no longer have the normal checks and balances in place that control and limit cell division. The process of cell division, whether normal or cancerous cells, is through the cell cycle. The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).

The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division. Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die. The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink. They also induce cell suicide (self-death, or apoptosis).

Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific. Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific. The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective. This is why chemotherapy is typically given in cycles.

Chemotherapy is most effective at killing cells that are rapidly dividing. Unfortunately, chemotherapy does not know the difference between the cancerous cells and normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur. The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss. Different drugs may affect different parts of the body.

Trifluridine/tipiricil belongs to the category of chemotherapy called antimetabolites. Antimetabolites are very similar to normal substances within the cell. When the cells incorporate these substances into the cellular metabolism, they are unable to divide. Antimetabolites are cell-cycle specific. They attack cells at very specific phases in the cycle. Antimetabolites are classified according to the substances with which they interfere.

Trifluridine is a thymidine-based nucleoside analog and tipiricil is a thymidine phosphorylase inhibitor. Trifluridine is able to work longer in the body because the tipiricil prevents its metabolism by thymidine phosphorylase (an enzyme). Trifluridine is taken into the cancer cells and incorporated into the DNA where it interferes with DNA synthesis which will then inhibit the cell's ability to divide.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

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