New oral combination chemotherapy for colorectal cancer

Lonsurf (trifluridine/tipiracil) is a new oral therapy for the treatment of metastatic colorectal cancer which allows patients to avoid long periods of IV treatment.

Lonsurf is taken orally within an hour after the morning and evening meals. | SCIENCE PHOTO LIBRARY
Lonsurf is taken orally within an hour after the morning and evening meals. | SCIENCE PHOTO LIBRARY

Lonsurf combines trifluridine, an antineoplastic thymidine-based nucleoside analogue, with tipiracil hydrochloride, a thymidine phosphorylase inhibitor, in either 15mg/6.14 mg or 20mg/8.19mg tablets.

Trifluridine is incorporated into cellular DNA via phosphorylation, thereby disrupting DNA function and cellular proliferation. Tipiracil hydrochloride prevents the normal degradation of trifluridine by thymidine phosphorylase.

Further information
View Lonsurf drug record
Summary of Product Characteristics
Manufacturer: Servier Laboratories
MIMS Cancer Clinic

Lonsurf is indicated in patients who have been previously treated with, or who are not considered candidates for, available treatments (including fluoropyrimidine-, oxiplatin- or irinotecan-based chemotherapies, anti-VEGF agents and anti-EGFR agents).

Evidence base

LonsurfFindings of the RECOURSE study (n=800) showed trifluridine/tipiracil to be superior to placebo in treating patients with metastatic colorectal cancer who were refractory to or unable to tolerate standard chemotherapies. Participants were randomised to receive either trifluridine/tipiracil (n=534) or placebo (n=266), both with best supportive care.

Median overall survival, the primary endpoint, was 7.1 months (95% CI 6.5-7.8) in the trifluridine/tipiracil group compared with 5.3 months (95% CI 4.6-6.0) in the placebo group (p<0.0001). One-year survival rates were also higher with trifluridine/tipiracil than placebo (26.6% vs 17.6%).

The most common adverse effects of trifluridine/tipiracil that resulted in treatment discontinuation or dose reduction, interruption or delay included neutropenia, anaemia, fatigue, diarrhoea and dyspnoea.

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