Trifluridine and tipiracil (Lonsurf)

Lonsurf is a type of chemotherapy drug. You might have Lonsurf as a treatment for bowel cancer that has spread to other parts of the body. Bowel cancer is cancer that started in the large bowel (colon) or back passage (rectum). Find out about how you have it, possible side effects and other important information.

How Lonsurf works

Lonsurf is made up of 2 drugs; trifluridine and tipiracil.

Trifluridine works by stopping the growth of cancer cells. Tipiracil helps the trifluridine to work longer by stopping it from being broken down by the body.

How you have it

You take Lonsurf as tablets, that you swallow with water. Your doctor will tell you how many tablets to take. You need to take them twice day, within an hour after your morning and evening meals.

Taking your tablets

You must take tablets according to the instructions your doctor or pharmacist gives you.

Speak to your pharmacist if you have problems swallowing the tablets.

Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, no more or less.

Talk to your specialist or advice line before you stop taking a cancer drug.

When you have Lonsurf

You take 2 tablets every day on days 1 to 5 and then 8 to 12, every 28 days. This 4 week period is called a cycle.

Week 1
  • Days 1 to 5 – take the tablets twice a day
  • Days 6 to 7 – don’t take the tablets
Week 2
  • Days 8 to 12 – take the tablets twice a day
  • Days 13 to 14 – don’t take the tablets
Weeks 3 and 4
  • Don’t take any of the tablets

Then you start the cycle again.

You usually take Lonsurf on its own, for as long as it helps you and the side effects aren't too bad. 

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (10%). You might have one or more of them. They include:

Increased risk of getting an infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Bruising, bleeding gums or nose bleeds (thrombocytopenia)

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Breathlessness (anaemia)

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Loss of appetite

You might not feel like eating and may lose weight. It is important to eat as much as you can. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss. 

Feeling tired (fatigue)

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Diarrhoea

Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days.

Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (1 to 10%). You might have one or more of them. They include:

  • weight loss
  • constipation – drink plenty and eat foods high in fibre. Your nurse can give you laxatives to help if needed
  • changes to your taste
  • feeling dizzy
  • a headache
  • feeling generally unwell (malaise)
  • liver changes picked up on blood tests
  • redness, swelling and pain on the palms of hands or soles of feet
  • numbness or tingling, usually in your fingers or toes
  • sore mouth or ulcers
  • protein in your urine – your nurse tests your urine before and during treatment
  • problems with staying or falling asleep (insomnia)
  • cough or shortness of breath – tell your doctor if you have any shortness of breath
  • skin problems such as a rash, itchy or flaky skin or flushing – talk to your team about any changes to your skin
  • tummy pain
  • low levels of albumin in your body that can cause swelling and weakness
  • hair loss – this is usually temporary and grows back after treatment finishes

Rare side effects

These side effects happen in fewer than 1 in 100 people (1%). You might have one or more of them. They include:

  • a blood clot – this can be life threatening. Signs are pain, redness and swelling where the clot is. Feeling breathless or pain in your chest or upper back can be a sign of a blood clot in the lung. Contact your advice line or go to A&E straight away
  • ear ache
  • indigestion
  • changes in blood pressure – it may be higher or lower than normal
  • eye problems such as changes to your sight, or red, sticky eyes that feel gritty and may water (conjunctivitis) or dry eyes – call your advice line about any eye problems
  • pain, including in your muscles, joints, bones or tumour
  • anxiety
  • changes to your periods (menstrual cycle)
  • changes to the levels of minerals and salts in your body – picked up on blood tests
  • kidney problems including kidney failure
  • passing out or fainting
  • high blood sugar levels
  • problems passing urine or loss of bladder control
  • changes in heart rhythm – you may have a heart trace (ECG) before and during your course of treatment. See your doctor or call 999 if you have chest pain

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Lactose

Lonsurf contains lactose. You shouldn't take this drug if you have a severe intolerance to lactose. Talk to your cancer doctor about this.

Pregnancy and contraception

This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Breastfeeding

Don’t breastfeed during this treatment because the drug may come through into your breast milk.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

  • other vaccines, but they might not give you as much protection as usual
  • the flu vaccine (as an injection)
  • the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system Open a glossary item recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Related links