Trifluridine and Tipiracil (Lonsurf)

1. TRIFLURIDINE AND TIPIRACIL (LONSURF) DRUG STUDY
Drug Order Mechanism of Action Drug
Indication
Contraindications Common Side Effects or
Adverse Effects
Nursing Considerations, Responsibility, and
Precautions
Brand Name:
Lonsurf
Generic Name:
Trifluridine
and Tipiracil
(Lonsurf)
Classification:
Thymidine
phosphorylase
inhibitors
Dosage: 35mg/m2
Route: PO
(Oral)
Timing or
Frequency: BID
(twice a day)
on Day 1-5 and
Day 8-12 of
each 28-day
cycle
Trifluridine:
Following uptake into
cancer cells,
trifluridine is
incorporated into DNA,
interferes with DNA
synthesis and inhibits
cell proliferation.
Trifluridine/tipiracil
demonstrated anti-
tumor activity against
KRAS wild-type and
mutant human
colorectal cancer
xenografts in mice.
Tipiracil: Inclusion
of tipiracil increases
trifluridine exposure
by inhibiting its
metabolism by
thymidine
phosphorylase.
Therapeutic Effect:
Inhibits tumor cell
growth and metastasis
Lonsurf is
indicated for the
treatment of adult
patients with
metastatic
colorectal cancer
previously treated
with
fluoropyrimidine-,
oxaliplatin-and
irinotecan-based
chemotherapy, an
anti-VEGF
biological therapy,
and if RAS wild-
type, an anti-EGFR
therapy.
Prednisone is
contraindicated in:
• During treatment
ANC <500 mm3 or
febrile
neutropenia,
platelets
<50,000/mm3 or
grade 3 or 4 non-
hematologic
toxicity
• OB: May cause
fetal harm
• Initial ANC
<1500/mm3 or
platelets
<75,000/mm3,
resolution of
grade 3 or 4
nonhematologic
toxicity to grade
0 or 1
• Moderate to
severe hepatic
impairment
• Lactation: Avoid
breastfeeding
• Hypersensitivity
to trifluridine
or tipiracil
• Asthenia or fatigue
• Pyrexia
• Nausea
• Diarrhea
• Vomiting
• Abdominal pain
• Stomatitis
• Decreased appetite
• Infections
• Dysgeusia
• Alopecia
• Anemia
• Neutropenia
• Thrombocytopenia
Nursing Implications
Patient Monitoring
• Obtain baseline CBC and screen
for anemia, neutropenia, and
thrombocytopenia.
• Obtain vital signs
• Verify pregnancy status before
start of each cycle
• Screen for active infection,
history of pulmonary embolism.
Assess hydration status.
• Question patient’s usual stool
characteristics (color,
frequency, and consistency)
Patient Teaching
• Treatment may cause fetal
harm. Female patients of
childbearing potential should
use effective contraception
during treatment. Immediately
report suspected pregnancy. Do
not breastfeed.
• Immediately report chest pain,
difficulty breathing, fast
heart rate, rapid breathing;
may indicate life-threatening
blood clot in the lungs.
• Report symptoms of bone marrow
suppression or infection such
as bruising easily, chills,
cough, dizziness, fainting,
fever, shortness of breath,

2. weakness, or burning with
urination.
• Report diarrhea, nausea,
vomiting that is not
controlled by antinausea.