| Metastasis from malignant neoplasm of colon and/or rectum

Lonsurf vs Zirabev

Side-by-side clinical, coverage, and cost comparison for metastasis from malignant neoplasm of colon and/or rectum.

Deep comparison between: Lonsurf vs Zirabev with Prescriber.AI

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Safety signalsZirabev has a higher rate of injection site reactions vs Lonsurf based on FDA-approved prescribing information

Coverage gaps3 major payers require step therapy for Zirabev but not Lonsurf, including UnitedHealthcare

Category

Lonsurf

Zirabev

At A Glance

RouteOral

FrequencyTwice daily, Days 1-5 and Days 8-12 of 28-day cycle

ClassNucleoside metabolic inhibitor

RouteIV infusion

FrequencyEvery 2-3 weeks

ClassVEGF inhibitor

Indications

Metastasis from malignant neoplasm of colon and/or rectum
Gastric Adenocarcinoma
Adenocarcinoma of the gastroesophageal junction

Metastasis from malignant neoplasm of colon and/or rectum
Non-Small Cell Lung Carcinoma
Glioblastoma
Renal Cell Carcinoma
Cervix carcinoma
Malignant neoplasm of ovary
Fallopian Tube Carcinoma
Primary Peritoneal Cancer

Dosing

Metastasis from malignant neoplasm of colon and/or rectum, Gastric Adenocarcinoma, Adenocarcinoma of the gastroesophageal junction 35 mg/m2 (max 80 mg per dose) orally twice daily with food on Days 1-5 and Days 8-12 of each 28-day cycle, as single agent or in combination with bevacizumab, until disease progression or unacceptable toxicity.

Severe Renal Impairment (CLcr 15-29 mL/min) 20 mg/m2 orally twice daily with food on Days 1-5 and Days 8-12 of each 28-day cycle; reduce to 15 mg/m2 twice daily if 20 mg/m2 is not tolerated; permanently discontinue if 15 mg/m2 is not tolerated.

Metastasis from malignant neoplasm of colon and/or rectum 5 mg/kg IV every 2 weeks with bolus-IFL; 10 mg/kg IV every 2 weeks with FOLFOX4; 5 mg/kg IV every 2 weeks or 7.5 mg/kg IV every 3 weeks with fluoropyrimidine-irinotecan- or fluoropyrimidine-oxaliplatin-based chemotherapy after progression on a first-line bevacizumab product-containing regimen.

Non-Small Cell Lung Carcinoma 15 mg/kg IV every 3 weeks in combination with carboplatin and paclitaxel.

Glioblastoma 10 mg/kg IV every 2 weeks.

Renal Cell Carcinoma 10 mg/kg IV every 2 weeks in combination with interferon alfa.

Cervix carcinoma 15 mg/kg IV every 3 weeks in combination with paclitaxel and cisplatin or paclitaxel and topotecan.

Malignant neoplasm of ovary, Fallopian Tube Carcinoma, Primary Peritoneal Cancer Stage III/IV following initial surgical resection: 15 mg/kg IV every 3 weeks with carboplatin and paclitaxel for up to 6 cycles, followed by 15 mg/kg every 3 weeks as a single agent for up to 22 cycles. Platinum-resistant recurrent: 10 mg/kg IV every 2 weeks with paclitaxel, pegylated liposomal doxorubicin, or topotecan (weekly); or 15 mg/kg IV every 3 weeks with topotecan (every 3 weeks). Platinum-sensitive recurrent: 15 mg/kg IV every 3 weeks with carboplatin and paclitaxel or carboplatin and gemcitabine for 6-10 cycles, followed by 15 mg/kg every 3 weeks as a single agent.

Contraindications

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Drug Interactions

859View drug interactions

232View drug interactions

Adverse Reactions

Most common (>=10%) Neutropenia, anemia, thrombocytopenia, fatigue, nausea, decreased appetite, diarrhea, vomiting, abdominal pain, pyrexia

Serious Severe myelosuppression (including febrile neutropenia), pulmonary emboli, interstitial lung disease (including fatal cases)

Most common (>10%) Epistaxis, headache, hypertension, rhinitis, proteinuria, taste alteration, dry skin, hemorrhage, lacrimation disorder, back pain, exfoliative dermatitis.

Serious Gastrointestinal perforations and fistulae, surgery and wound healing complications, hemorrhage, arterial thromboembolic events, venous thromboembolic events, hypertension, posterior reversible encephalopathy syndrome, renal injury and proteinuria, infusion-related reactions, ovarian failure, congestive heart failure.

Postmarketing Polyserositis, pulmonary hypertension, mesenteric venous occlusion, gastrointestinal ulcer, intestinal necrosis, anastomotic ulceration, pancytopenia, gallbladder perforation, osteonecrosis of the jaw, renal thrombotic microangiopathy, nasal septum perforation, arterial aneurysms/dissections/rupture.

Pharmacology

LONSURF combines trifluridine, a thymidine-based nucleoside analog that is incorporated into DNA to interfere with DNA synthesis and inhibit cell proliferation, and tipiracil, a thymidine phosphorylase inhibitor that increases trifluridine systemic exposure by blocking its primary metabolic pathway.

Bevacizumab-bvzr binds VEGF and prevents its interaction with receptors Flt-1 and KDR on the surface of endothelial cells, inhibiting endothelial cell proliferation, new blood vessel formation, and metastatic disease progression.

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Most Common Insurance

Anthem BCBS

Lonsurf