An oral chemotherapy for advanced bowel and stomach cancer
Trifluridine with tipiracil
An oral chemotherapy tablet used for advanced bowel and stomach cancer, usually after other treatments have been tried.
What is Trifluridine with tipiracil?
Trifluridine with tipiracil is a specialist chemotherapy taken as tablets, used for advanced bowel (colorectal) and stomach (gastric) cancer, usually after other treatments have been tried. It combines two ingredients: trifluridine, which damages cancer cells, and tipiracil, which helps trifluridine stay active in the body. Its main risk is lowering the blood counts (especially the white cells that fight infection), which can lead to serious infections, so blood tests and watching for signs of infection are essential. It also commonly causes tiredness, nausea and bowel upset. It is taken under the care of a cancer specialist team, with contraception important because it can harm an unborn baby.
Education and reference only. This is a plain-language guide to Trifluridine with tipiracil — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Trifluridine with tipiracil is an oral chemotherapy used to treat advanced bowel (colorectal) cancer and stomach (gastric) cancer, usually when earlier treatments are no longer working. It is a combination tablet: trifluridine is the active chemotherapy that gets taken up by cancer cells and disrupts their DNA, while tipiracil stops trifluridine being broken down too quickly so that more of it reaches the cancer. Because it is taken by mouth, it can be used at home, but it is still chemotherapy and needs careful monitoring under a specialist cancer team.
How it works
The trifluridine part of this medicine is taken up by dividing cells and built into their DNA, which damages the DNA and stops cancer cells from multiplying, eventually causing them to die. The tipiracil part does not attack cancer itself; instead it blocks an enzyme that would otherwise break trifluridine down in the body, so more of the active medicine reaches the cancer. Because the trifluridine affects fast-dividing cells in general, it also affects healthy fast-dividing cells, particularly those in the bone marrow that make blood cells, which is why lowering of the blood counts and the resulting infection risk is its main concern.
Company & origin
Originated / developed by: Specialist manufacturer.
A specialist oral chemotherapy used in the UK for advanced bowel (colorectal) and stomach (gastric) cancer, usually after other treatments.
Practical use
How to take Trifluridine with tipiracil
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take the tablets by mouth with food, in cycles with rest periods, exactly as your specialist team directs.
- Have your blood tests before each cycle, as the medicine lowers the blood counts.
- Treat any fever, chills, sore throat or feeling unwell as an emergency and contact your team or go to hospital straight away.
- Wash your hands after handling the tablets and follow any advice on safe handling, as it is chemotherapy.
- Use effective contraception during treatment and for the period your team advises, as it can harm an unborn baby.
Weighing it up
Advantages & disadvantages of Trifluridine with tipiracil
Advantages
- An oral chemotherapy option for advanced bowel and stomach cancer when other treatments are no longer working.
- Taken at home as tablets rather than always needing hospital infusions.
- Combines two ingredients so more of the active medicine reaches the cancer.
Disadvantages
- Lowers the blood counts, raising the risk of serious infection, so close blood-test monitoring is needed.
- Commonly causes tiredness, nausea and bowel upset.
- Is still chemotherapy, needing careful handling and contraception, and can harm an unborn baby.
Practical use
Good to know
The most important safety point with trifluridine with tipiracil is that it lowers the blood counts, especially the white cells that fight infection (neutropenia), but also the red cells and platelets. This means there is a real risk of serious infection, so blood tests are done before each cycle, and any sign of infection, such as a high temperature, chills, a sore throat or feeling generally unwell, should be treated as an emergency and reported straight away. It also commonly causes tiredness, nausea, reduced appetite and bowel upset such as diarrhoea or sickness. It is taken in cycles with rest periods, and the tablets are taken with food. As chemotherapy, it should be handled carefully, and effective contraception is important because it can harm an unborn baby.
Who should not take it / use with caution
- People who have had a serious allergic reaction to trifluridine or tipiracil should not take it.
- It is used with great care, or delayed, in people with low blood counts or an active infection.
- It is avoided in pregnancy because it can harm an unborn baby and is not recommended while breastfeeding.
Monitoring
- Regular blood counts before each cycle and as advised, to check white cells, red cells and platelets.
- Watching for signs of infection, which should be treated urgently.
- Reviewing kidney and liver function and how the cancer is responding with scans.
Side effects
- A fall in the white cells that fight infection, raising the risk of serious infection.
- Tiredness, nausea, vomiting, reduced appetite and diarrhoea.
- A fall in red cells (anaemia) causing tiredness and breathlessness, or a fall in platelets causing easy bruising.
- Less commonly but seriously, severe infections, including blood infection (sepsis), and severe bowel inflammation.
Key interactions
- Other medicines that lower the blood counts can add to the risk, so tell your team about everything you take.
- Live vaccines are generally avoided during treatment because the immune system is weakened.
- Always give your team a full list of your medicines, including anything bought over the counter.
Available as: Tablets taken by mouth.
Answers
Trifluridine with tipiracil: frequently asked questions
What is trifluridine with tipiracil used for?
It is an oral chemotherapy for advanced bowel (colorectal) and stomach (gastric) cancer, usually used after other treatments are no longer working.
Why are there two ingredients?
Trifluridine is the chemotherapy that damages cancer cells, while tipiracil stops it being broken down too quickly so more of it reaches the cancer.
Why do I need regular blood tests?
It lowers the blood counts, especially the white cells that fight infection, so blood tests check your counts before each cycle.
What should I do if I get a temperature?
Treat a fever, chills, sore throat or feeling unwell as an emergency and contact your team or go to hospital straight away, as it could signal a serious infection.
Do I take it with food?
Yes, the tablets are taken with food, in cycles with rest periods, exactly as your specialist team directs.
The wider class
About Oral cytotoxic chemotherapy (combination tablet)
Trifluridine with tipiracil belongs to the oral cytotoxic chemotherapy (combination tablet) class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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