Colorectal Cancer: Patient Follow-Up with Trifluridine/Tipiracil
Insights From:John L. Marshall, MD, Georgetown University Hospital;Mohamed E. Salem, MD, Georgetown University Hospital;Monica Chacha, RN, BSN, OCN, Georgetown University Hospital
John L. Marshall, MD: So, that first visit back after somebody has been started on Lonsurf (TAS-102), is that day 15 or day 28 for you?
Mohamed E. Salem, MD: Usually day 15.
John L. Marshall, MD: And you’re doing a CBC (complete blood count), so it’s right after they finish their first 2 weeks. And they need a CBC then anyway. So, a typical visit is a CBC, quick physical exam, typically not a lot of side effects. If they’ve had nausea, we’ve heard about it already by then. Any tricks on managing the nausea for the Lonsurf because it is continuous treatment?
Monica Chacha, RN: Usually, people that I’ve found are fine taking Zofran. It works pretty well.
John L. Marshall, MD: Typical stuff that we use for that.
Monica Chacha, RN: Yes.
John L. Marshall, MD: Any other tricks on that first? How about the use of growth factors on day 15? They come in, their ANC is 300.
Mohamed E. Salem, MD: I like to wait a month until I see how they’re going to behave, but I shy away from using the growth factor in the first cycle. But if this keeps happening and I end up delaying the dose, at the start of the cycle, I might endorse a second growth factor.
John L. Marshall, MD: And I think it’s important if they come back with that first round of myelosuppression at day 28 and the counts are still low, the recommendation—and pretty much what I do—is delay a week. You might be able to get around it with the same dose the second cycle, because you do want to get them through those first couple of months to see if they’re going to benefit from the treatment. But then if it continues to delay, then either growth factor or dose reduction, right?
Mohamed E. Salem, MD: Yes. One thing I like to mention: when you start the medicine on patients, especially younger adults, a lot of them, even if they don’t ask the question, wonder about pregnancy, about even their relationship with their spouses. Some people ask, “Is that going to affect me?” And intentionally, even if you didn’t ask, I like to bring it into the discussion to make sure at least this has been addressed during the visit.
John L. Marshall, MD: What’s the answer?
Mohamed E. Salem, MD: We tell them, of course, you should not be pregnant or get pregnant while you’re taking the medication.
John L. Marshall, MD: Absolutely. But how about just regular sexual activity?
Mohamed E. Salem, MD: I say that’s fine.
Monica Chacha, RN: Something I always tell my patients is that I would rather them overcommunicate than undercommunicate. Sometimes, people tell me they didn’t want to tell me something, they thought it was insignificant. But that’s why I’m here, that’s why I have this role. So, even if you think it’s nothing, I tell my patients at least shoot me an e-mail or give me a call. Let me and the physician decide if it’s nothing or if it might be something that can turn into something bigger later, and we can stop it before it becomes a problem.