Can Lonsurf (trifluridine/tipiracil) be given for appendicitis?

Lonsurf (Trifluridine/Tipiracil) Is Not Indicated for Appendicitis Treatment

Lonsurf (trifluridine/tipiracil) should not be used for the treatment of appendicitis as it is specifically approved only for metastatic colorectal cancer and has no role in infectious or inflammatory conditions such as appendicitis. 1

Appropriate Management of Appendicitis

Acute appendicitis requires either surgical intervention or specific antibiotic therapy depending on the clinical presentation and patient factors:

Diagnosis and Risk Stratification

• Use validated scoring systems (Alvarado, AIR, or AAS scores) to stratify risk 2
• Imaging is recommended for confirmation:
  • Ultrasound as first-line imaging in children and young adults 2
  • CT scan when ultrasound is inconclusive or in patients over 40 years 2

Treatment Options

1. Surgical Management

• Laparoscopic appendectomy remains the standard treatment for acute appendicitis 3
• Indicated for:
  • Patients with CT findings suggesting higher risk of treatment failure (appendicolith, mass effect, dilated appendix >13mm) 2, 4
  • Patients with failed antibiotic therapy 2
  • Patients with worsening clinical status 2

2. Non-Operative Management (NOM) with Antibiotics

• Appropriate for uncomplicated appendicitis confirmed by imaging 3, 2
• Recommended antibiotic regimens:
  • Piperacillin-tazobactam
  • Ampicillin-sulbactam
  • Ticarcillin-clavulanate
  • Cephalosporins or fluoroquinolones with metronidazole 2, 4
• Initial IV antibiotics with transition to oral after 48 hours 3, 2
• Success rate of approximately 70% in uncomplicated cases 4

3. Special Populations

• Elderly patients:

  • NOM may be considered in selected elderly patients with uncomplicated appendicitis who wish to avoid surgery or have significant comorbidities 3, 2
  • Surgical management shows decreased mortality risk in elderly patients after controlling for comorbidities 3

• Complicated appendicitis:

  • Postoperative antibiotics recommended for 3-5 days 3
  • Percutaneous drainage may be considered for appendiceal abscess when laparoscopic expertise is not available 3

Why Lonsurf Is Not Appropriate for Appendicitis

Lonsurf (trifluridine/tipiracil) is:

• An antimetabolite agent approved only for metastatic colorectal cancer 1
• Works by incorporating trifluridine into DNA to inhibit cell proliferation 1
• Has no antimicrobial properties required to treat an infectious condition like appendicitis
• Associated with significant hematologic adverse effects including anemia, neutropenia, thrombocytopenia, and leukopenia 1

Common Pitfalls in Appendicitis Management

• Delaying surgical intervention in cases with high risk of perforation (17-32% of cases) 5
• Failing to provide adequate pain control (opioids, NSAIDs, and acetaminophen should be used as needed and do not mask symptoms or delay diagnosis) 5
• Prolonged antibiotic therapy beyond 3-5 days for complicated appendicitis with adequate source control 3
• Routine interval appendectomy after successful non-operative management (not recommended in young adults and children) 3

In conclusion, appendicitis treatment should focus on either surgical management or appropriate antibiotic therapy. Lonsurf has no role in appendicitis treatment and should only be used for its approved indication of metastatic colorectal cancer.