# RECOURSE

Source: https://onco.cc/trials/recourse/  
OnCo record `recourse` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

An oral chemotherapy tablet that still works after fluorouracil has stopped working, because the active part is built into DNA rather than blocking an enzyme.

## Summary

RECOURSE randomised 800 patients with refractory metastatic colorectal cancer 2:1 to trifluridine/tipiracil (TAS-102) or placebo. Median overall survival improved from 5.3 to 7.1 months (hazard ratio 0.68, 95% CI 0.58 to 0.81). Trifluridine is incorporated into DNA rather than inhibiting thymidylate synthase, which is why it retains activity after fluoropyrimidine failure, and tipiracil blocks its degradation. Neutropenia is the main toxicity. The FDA approved it in September 2015, the EU marketing authorisation for Lonsurf followed on 25 April 2016 and NICE recommended it in England in August 2016 (TA405). SUNLIGHT later showed that adding bevacizumab is better still.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-09-24
- Registry id: NCT01607957
- Phase: 3
- Setting: Refractory metastatic colorectal cancer after all standard chemotherapies: trifluridine/tipiracil against placebo
- Sponsor: Taiho Oncology
- Enrolled: 800
- Result: Median overall survival 7.1 against 5.3 months (hazard ratio 0.68).
- Outcomes: Overall survival: Trifluridine/tipiracil 7.1 months vs Placebo 5.3 months, HR 0.68
- Replication: Superseded in practice by SUNLIGHT, which added bevacizumab and reached 10.8 months.

## Sources

- ClinicalTrials.gov NCT01607957: https://clinicaltrials.gov/study/NCT01607957
- RECOURSE: randomized trial of TAS-102 for refractory metastatic colorectal cancer (New England Journal of Medicine 2015): https://doi.org/10.1056/NEJMoa1414325
- NICE TA405: trifluridine-tipiracil for previously treated metastatic colorectal cancer: https://www.nice.org.uk/guidance/ta405
- EMA Lonsurf: https://www.ema.europa.eu/en/medicines/human/EPAR/lonsurf

## Connected records

- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/)
- technologies: [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/)
- drugs: [Trifluridine/tipiracil](https://onco.cc/drugs/trifluridine-tipiracil/)
- companies: [Servier](https://onco.cc/companies/servier/), [Taiho Pharmaceutical (Otsuka)](https://onco.cc/companies/taiho/)
- trials: [SUNLIGHT](https://onco.cc/trials/sunlight/)

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