Cancer drugs A to Z list
Trifluridine-tipiracil (Lonsurf) and bevacizumab is a cancer drug combination. You pronounce these drug names as:
lon-sur-f
bev-a-ciz-oo-mab
It is a treatment for or bowel cancer.
You might have Lonsurf and bevacizumab if you have already had 2 or more treatments and they are no longer working.
Lonsurf is a type of chemotherapy made up of 2 drugs, trifluridine and tipiracil. Trifluridine works by stopping the growth of cancer cells. Tipiracil helps the trifluridine to work longer in the body by stopping it from being broken down.
Bevacizumab is a called an angiogenesis inhibitor. It targets a cancer cell protein called vascular endothelial growth factor (VEGF). This protein helps cancers grow blood vessels so they can get food and oxygen from the blood. All cancers need a blood supply to survive and grow.
Bevacizumab blocks this protein and stops the cancer from growing blood vessels, so it is starved and can't grow.
Find out about anti angiogenic drugs
You take Lonsurf as a tablet. You have bevacizumab as a drip into your bloodstream.
You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:
central line
PICC line
portacath
You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.
Read more about having treatment into a vein
You take Lonsurf as tablets.
Your doctor will tell you how many tablets to take. You take them with a glass of water. You need to take them within an hour after your morning and evening meals.
Speak to your pharmacist if you have problems swallowing the tablets.
Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.
You should take the right dose, no more or less.
Talk to your healthcare team before you stop taking a cancer drug or if you miss a dose.
You have Lonsurf and bevacizumab as cycles of treatment. This means you have the drugs and then a rest to allow your body to recover.
Each cycle of treatment lasts 28 days (4 weeks).
Depending on your hospital and situation you have your first dose of bevacizumab over 30 to 90 minutes. If you don't have any problems, further treatments usually take around 30 minutes or less.
You have a cycle of treatment in the following way:
You have bevacizumab as a drip into your bloodstream.
You take Lonsurf twice a day.
You take Lonsurf twice a day.
You have no treatment.
You take Lonsurf twice a day.
You have no tretament.
You have bevacizumab as a drip into your bloodstream.
You have no treatment.
You then start the next cycle of treatment.
You take Lonsurf and bevacizumab for as long as the treatment is working and you are not experiencing too many side effects.
You have blood tests before and during your treatment. They check your levels of and other substances in the blood. They also check how well your liver and kidneys are working.
Before treatment starts you may have a blood test to check for viruses such as hepatitis B, hepatitis C, and HIV. This is called a viral screen.
It’s important for your doctor to know if you have had any of these viruses. This is because this treatment can weaken your and can cause the virus to become active again (reactivation).
You might also have blood pressure and urine checks. Or an to see how well your heart works.
Side effects can vary from person to person. They also depend on what other treatments you're having.
Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
you have severe side effects
your side effects aren’t getting any better
your side effects are getting worse
Early treatment can help manage side effects better.
We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.
Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.
These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:
Increased risk of getting an infection is due to a drop in . Symptoms include a change in temperature, aching muscles, cough, headaches, feeling cold and shivery, pain or a burning feeling when peeing or generally feeling unwell. You might have other symptoms depending on where the infection is.
Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.
This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs. This is known as petechiae.
Blood clots can develop in the deep veins of your body, usually the leg. This is called deep vein thrombosis (DVT). A blood clot can be very serious if it travels to your lungs (pulmonary embolism), although this isn’t common.
Symptoms of a blood clot include:
pain, redness and swelling around the area where the clot is and may feel warm to touch
breathlessness
pain in your chest or upper back – dial 999 if you have chest pain
coughing up blood
You might get high blood pressure. Symptoms can include headaches, nosebleeds, blurred or double vision or shortness of breath.
Less commonly you may get low blood pressure.
Rarely, this treatment can cause very high blood pressure. This might be life threatening needing immediate medical treatment. Symptoms include a headache, feeling and being sick, loss of eyesight, seizures and loss of consciousness.
You have your blood pressure checked regularly. Tell your doctor or nurse if you have any of these symptoms.
Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.
It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.
Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers.
You can have painkillers to reduce the soreness. Take them half an hour before meals to make eating easier.
You might feel very tired and as though you lack energy.
Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.
Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.
Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain . But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables.
Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.
is easier to sort out if you treat it early. Drink plenty and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your healthcare team if you think you are constipated. They can give you a if needed.
Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Tell your healthcare team if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons.
This can include a low level of in your blood. The symptoms can include dark coloured pee, tiredness, weak muscles, loss of appetite or swelling in your feet and legs.
You might also have high levels of protein in your pee. The symptoms can include frothy pee or swelling in the face, eyes, hands or ankles (oedema).
You will have regular blood tests to check how well your kidneys are working.
You might not feel like eating and may lose weight. Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietitian if you are concerned about your appetite or weight loss.
You won't have bevacizumab until at least 28 days after surgery or until any wounds have completely healed.
Any wounds you might have can take longer to heal. Keep wounds clean to prevent infection. Contact your GP or specialist nurse if you are worried about a wound.
You might have changes to your . This can include bleeding from your bottom (rectum). This may appear as bright red blood in your poo (stools) or on toilet paper.
Less commonly, you may develop problems such as a blockage (obstruction) in your gut, a tear in the bowel wall or your bowel may stop working. You may have pain in your bottom due to spasms.
Rarely you can have inflammation of the bowel and back passage (anus).
Contact your healthcare team if you have any bleeding, pain, discharge or bowel changes not normal for you.
You might get pain in your tummy (abdomen), muscles and joints. Less commonly you may have pain in different areas of the body such as your back, pelvis or back passage (anus).
Rarely you might have pain in your arms, legs and bones.
Let your doctor or nurse know about any pain so that they can give you painkillers to help.
Tell your healthcare team straight away if you get a high temperature. Ask them if you can take paracetamol to help lower your temperature.
Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.
Skin problems include a skin rash, dry, flaking or inflamed skin and itching. You may experience changes to the colour of your skin. This means you might have areas that go lighter or darker than your normal skin tone.
Less commonly the skin on your hands or feet may become red, sore, tender, peel, or develop blisters.
Rarely you may develop itchy bumps (hives) on your skin.
Let your healthcare team know of any skin changes. They can tell you what you can use to help your skin.
Taste changes may make you go off certain foods and drinks. You may also find that some foods taste different from usual or that you prefer to eat spicier foods. Your taste gradually returns to normal a few weeks after your treatment finishes.
Watery eyes is also called excessive tearing or epiphora (pronounced ep-if-or-ah). Tell your doctor or nurse if this is a problem for you. They can prescribe medicines to help. Try to avoid dust, pollen or animal hairs as they can make the watering worse.
Rarely you might have red, dry, swollen, itchy, sticky or sore eyes (conjunctivitis).
You might have a runny nose or a sore, blocked nose that makes you sneeze.
You might have difficulty speaking, slurred speech or slower speech than usual. Talk to your doctor if this happens.
More rarely, you might find that your voice becomes hoarse.
You might have a cough or feel short of breath. Let your doctor know if this happens.
You may have changes in levels of minerals and salts in your blood, including low levels of sodium or magnesium.
Rarely you might have high potassium levels, symptoms can include muscle weakness, tingling, nausea or a faster heartbeat.
You have regular blood tests during treatment to check this.
The ovaries may stop working in women and periods may stop. This may only be temporary and may go back to normal once you stop treatment. But some women might have an and this treatment could cause infertility.
These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:
sepsis - a serious reaction to an infection. Signs can include feeling very unwell, not peeing, a very high or very low temperature, shivering, slurred speech or confusion, breathlessness, mottled or discoloured skin, extreme shivering or muscle pain. Call 999 or go to accident and emergency (A&E) immediately if you have any of these symptoms
a stroke - symptoms can include drooping of one side of the face, being unable to smile, having numbness or weakness on one side of the body or being unable to talk. Dial 999 immediately if you have these symptoms
heart failure
an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness - some allergic reactions can be life threatening. Tell your nurse straight away if you feel unwell or notice any of these symptoms
a fast heartbeat
dizziness
feeling very drowsy
hair loss
high levels of in your blood – symptoms include yellowing of skin or eyes
liver changes – picked up on blood tests
fainting
not enough fluid in your body (dehydration) – symptoms may include feeling thirsty, peeing less, dark coloured or strong smelling pee or feeling very tired
an abnormal opening (fistula) between on the inside of your body and skin or other tissues that are not usually connected
coughing up blood or bleeding from other parts of the body. Let your healthcare team know straight away if you notice you have any signs of bleeding
low levels of oxygen in your body tissues – symptoms may include confusion, restlessness, difficulty breathing, a fast heartbeat and bluish skin
fluid build up in your body (oedema)
feeling generally unwell
muscle weakness
These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:
indigestion
farting (flatulence)
nail problems – including flaky, cracked, sore nails
changes to your periods (menstrual cycle)
changes in the brain that are usually reversible, causing a sudden onset of symptoms including headaches, dizziness, confusion, fits (seizures) and changes to your vision
a feeling like the room is spinning (vertigo)
earache
an increase in the level of in your blood this can cause gout - you have blood tests to check for this
anxiety
high blood sugar levels
difficulty sleeping
shingles
sweating
There isn't enough information to work out how often these side effects might happen. You might have one or more of them. They include:
damage to the jaw bone (osteonecrosis)
a stomach ulcer
If you have side effects that aren’t listed on this page, you can look at the individual drug pages:
We have more information about side effects and tips on how to cope with them.
Cancer drugs can interact with medicines, herbal products, and some food and drinks. We do not list these interactions on this page. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.
Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.
You may not be able to become pregnant or get someone pregnant after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.
This treatment may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you're having treatment and for at least 6 months afterwards.
Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.
Don’t breastfeed during this treatment and for 6 months afterwards. This treatment may come through in the breast milk.
If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.
Do not have live vaccines while you’re having treatment and for up to 12 months afterwards. For some people, it may be longer than this. The length of time you need to avoid live vaccines depends on the treatment you’ve had.
Ask your doctor or pharmacist how long you should avoid live vaccinations.
In the UK, live vaccines include rubella, mumps, measles, chickenpox, BCG, and yellow fever. You can usually have non-live vaccines. But they might not give you as much protection as usual. These include the:
flu vaccine, as an injection
coronavirus (COVID-19) vaccine
Talk to your doctor or pharmacist about the best time to have a vaccine in relation to your cancer treatment.
You can be in contact with other people who have had live vaccines as injections. If someone has had a live vaccine by mouth or nasal spray there may be a small risk the vaccine virus can be passed onto you if your is weakened.
Your healthcare team will let you know if you need to take any precautions if you are in close contact with someone who has had a live vaccine.
For further information about each drug and the possible side effects go to the electronic medicines compendium (emc) website. You can find patient information leaflets for each drug on this website.
You can report any side effect you have to the Medicines and Healthcare Regulatory Agency (MHRA) as part of their Yellow Card Scheme.
Last reviewed: 17 Sept 2026
Next review due: 17 Sept 2029
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