From the Guidelines
When using Lonsurf (trifluridine/tipiracil), it is crucial to take precautions to minimize the risk of myelosuppression and other serious side effects, as recommended in the latest clinical guidelines, such as those from the Chinese Society of Clinical Oncology (CSCO) 1. To minimize risks, patients should be closely monitored with regular blood tests to check for low blood cell counts, and they should immediately report any signs of infection, unusual bleeding or bruising, or severe fatigue to their healthcare provider.
- Key precautions include:
- Informing healthcare providers about all medications and medical conditions, especially bone marrow suppression, kidney or liver problems, or pregnancy/breastfeeding status
- Taking Lonsurf exactly as prescribed, within one hour after morning and evening meals
- Handling the tablets with care to avoid crushing or breaking them
- Staying well-hydrated during treatment
- Using effective contraception to prevent pregnancy, as Lonsurf can harm a developing fetus
- Avoiding live vaccines while on this medication
- Common side effects of Lonsurf include nausea, vomiting, diarrhea, and fatigue, which should be managed under the guidance of a healthcare provider. The dosing regimen, as outlined in the CSCO guidelines 1, is typically 35 mg/m2 (with a maximum single dose of 80mg) orally, twice a day, on specific days of a 28-day cycle, and may be adjusted based on individual patient needs and response to treatment.
From the Research
Precautions when using Lonsurf
When using Lonsurf, which contains trifluridine/tipiracil, several precautions should be taken into consideration:
- Renal Impairment: Patients with renal impairment are at a higher risk of developing severe neutropenia, a dose-limiting toxicity of trifluridine/tipiracil treatment 2, 3, 4.
- Neutropenia: Severe neutropenia is a common side effect of trifluridine/tipiracil treatment, and its development can reflect better treatment outcomes 2, 5, 6.
- Dose Reduction: The dose of trifluridine/tipiracil may need to be reduced in patients who develop severe neutropenia or other toxicities 5.
- Monitoring: Patients receiving trifluridine/tipiracil should be closely monitored for signs of neutropenia and other toxicities, and their treatment should be adjusted accordingly 4, 6.
- Combination with Bevacizumab: The combination of trifluridine/tipiracil with bevacizumab may increase the risk of neutropenia, and patients should be closely monitored for this side effect 3, 4, 6.
Risk Factors for Severe Neutropenia
Several risk factors for severe neutropenia have been identified in patients receiving trifluridine/tipiracil, including:
- Renal Impairment: Renal impairment is a significant risk factor for severe neutropenia in patients receiving trifluridine/tipiracil 2, 3, 4.
- Baseline Neutropenia: Patients with baseline neutropenia are at a higher risk of developing severe neutropenia during trifluridine/tipiracil treatment 2.
- Absolute Neutrophil Count: A lower absolute neutrophil count is associated with a higher risk of severe neutropenia in patients receiving trifluridine/tipiracil 3.
Clinical Implications
The development of severe neutropenia in patients receiving trifluridine/tipiracil can have significant clinical implications, including:
- Dose Reduction or Interruption: Severe neutropenia may require dose reduction or interruption of trifluridine/tipiracil treatment 5.
- Increased Risk of Infections: Severe neutropenia can increase the risk of infections, which can be life-threatening in some cases 5.
- Impact on Treatment Outcomes: The development of severe neutropenia can reflect better treatment outcomes in patients receiving trifluridine/tipiracil 2, 5, 6.