CLINICAL TRIALS PROFILE FOR TRIFLURIDINE

505(b)(2) Clinical Trials for trifluridine

This table shows clinical trials for potential 505(b)(2) applications. See the next table for all clinical trials

Trial Type	Trial ID	Title	Status	Sponsor	Phase	Start Date	Summary
New Combination	NCT07235293 ↗	A Study to Test DSP107 in Combination With Atezolizumab in Comparison With Fruquintinib as a New Treatment for Colorectal Cancer.	NOT_YET_RECRUITING	Novotech (Australia) Pty Limited	PHASE2	2025-11-15	This clinical study is testing whether a new combination of medicines (DSP107 and atezolizumab) is more effective and safer than an existing treatment (fruquintinib) for people with advanced colorectal cancer that is microsatellite stable (MSS). Participants will be randomly assigned to receive one of the two treatments, and researchers will monitor how well the cancer responds, how safe the treatments are, and how the body processes them. The study hopes to show that the new combination can improve outcomes for patients with this type of colorectal cancer.
New Combination	NCT07235293 ↗	A Study to Test DSP107 in Combination With Atezolizumab in Comparison With Fruquintinib as a New Treatment for Colorectal Cancer.	NOT_YET_RECRUITING	Kahr Bio Australia Pty Ltd	PHASE2	2025-11-15	This clinical study is testing whether a new combination of medicines (DSP107 and atezolizumab) is more effective and safer than an existing treatment (fruquintinib) for people with advanced colorectal cancer that is microsatellite stable (MSS). Participants will be randomly assigned to receive one of the two treatments, and researchers will monitor how well the cancer responds, how safe the treatments are, and how the body processes them. The study hopes to show that the new combination can improve outcomes for patients with this type of colorectal cancer.

All Clinical Trials for trifluridine

Trial ID	Title	Status	Sponsor	Phase	Start Date	Summary
NCT00000138 ↗	Herpetic Eye Disease Study (HEDS) I	Unknown status	National Eye Institute (NEI)	Phase 3	1989-05-01	To evaluate the efficacy of topical corticosteroids in treating herpes simplex stromal keratitis in conjunction with topical trifluridine. To evaluate the efficacy of oral acyclovir in treating herpes simplex stromal keratitis in patients receiving concomitant topical corticosteroids and trifluridine. To evaluate the efficacy of oral acyclovir in treating herpes simplex iridocyclitis in conjunction with treatment with topical corticosteroids and trifluridine.
NCT00000635 ↗	Treatment of Acyclovir-Resistant Mucocutaneous Herpes Simplex Disease in Patients With AIDS: Open Label Pilot Study of Topical Trifluridine	Completed	Glaxo Wellcome	N/A	1969-12-31	To determine the safety, effectiveness, and toxicity of topical (local) trifluridine in treating mucocutaneous (at the nasal, oral, vaginal, and anal openings) Herpes simplex virus ( HSV ) disease that has shown resistance to acyclovir in HIV-infected patients. HSV infection in patients with AIDS is often associated with skin sores and frequent recurrences. Treatment with the drug acyclovir results in healing for most patients, but repeated treatment sometimes results in resistance of the virus to acyclovir. Thus, when this happens, other treatments need to be used. Trifluridine is an antiviral drug that is used for the treatment of Herpes infections that occur in the eye. This study attempts to determine if trifluridine is useful for treating HSV sores that have not healed after treatment with acyclovir.
NCT00000635 ↗	Treatment of Acyclovir-Resistant Mucocutaneous Herpes Simplex Disease in Patients With AIDS: Open Label Pilot Study of Topical Trifluridine	Completed	National Institute of Allergy and Infectious Diseases (NIAID)	N/A	1969-12-31	To determine the safety, effectiveness, and toxicity of topical (local) trifluridine in treating mucocutaneous (at the nasal, oral, vaginal, and anal openings) Herpes simplex virus ( HSV ) disease that has shown resistance to acyclovir in HIV-infected patients. HSV infection in patients with AIDS is often associated with skin sores and frequent recurrences. Treatment with the drug acyclovir results in healing for most patients, but repeated treatment sometimes results in resistance of the virus to acyclovir. Thus, when this happens, other treatments need to be used. Trifluridine is an antiviral drug that is used for the treatment of Herpes infections that occur in the eye. This study attempts to determine if trifluridine is useful for treating HSV sores that have not healed after treatment with acyclovir.
NCT00002037 ↗	Evaluation of the Therapeutic Benefit of r-metHuIFN- Gamma in AIDS Patients With Disseminated Mycobacterium Avium-Intracellulare (MAI) Infection: A Multi-Centered Pilot Study	Completed	Amgen	N/A	1969-12-31	To examine the effectiveness of subcutaneous gamma interferon in reducing severity of Mycobacterium avium- intracellulare (MAI) bacillemia episodes in AIDS patients in an open-label dose-randomized multi-center pilot clinical investigation. To evaluate the safety of gamma interferon given by subcutaneous injection (SC) in the AIDS patient in the presence and absence of AZT therapy.
NCT00081835 ↗	Evaluation and Treatment of Eye Complications of Vaccinia Vaccination	Completed	National Eye Institute (NEI)	Phase 2	2004-04-19	This study will evaluate patients with eye complications related to vaccination against smallpox to learn more about these conditions. Vaccinia vaccination has been used for more than 100 years for preventing smallpox. A small number of people who receive the vaccination (less than 1 in 1,000) develop complications, sometimes in their eyes. This usually results from the accidental transfer of the infection from the vaccination site to the face or eyes, perhaps by touching the vaccination area and then the face or eyelids before washing the hands. The study will also examine whether an experimental treatment called NP-016 vaccinia immune globulin can reduce corneal scarring that is sometimes associated with serious vaccinia complications and can impair vision. Children and adults with keratitis, severe conjunctivitis, or blepharitis following exposure to vaccinia vaccination may be eligible for this study. Children must weigh at least 10 kg. Participants undergo the following tests and procedures at enrollment, with some tests repeated at scheduled study visits: 1. Medical history and physical examination 2. Infectious disease consultation 3. Complete eye evaluation including: - Fundus photography to examine the back of the eye - dilation of the pupils with eye drops to examine and photograph the back of the eye - Slit lamp biomicroscopy - evaluation of the front part of the eye with a slit lamp microscope - Eye pressure measurements - Eye swab to look for vaccinia virus or other causes of disease 4. Blood tests 5. Photographs and documentation of eye and skin lesions 6. Vaccinia diagnostic tests, such as skin or mucosa scrapings; blood, throat, or urine cultures; and tissue biopsies, if needed Patients begin treatment with standard medications for their eye disease, such as trifluridine (Viroptic® (Registered Trademark)) anti-viral eye drops. Patients whose condition becomes serious are offered additional treatment with intravenous (through a vein) infusions of either VIG or placebo (salt water solution with no active drug) and are randomly assigned to one or the other treatment group. All patients continue standard-of-care treatment as well. Follow-up visits at the NIH eye clinic are scheduled as required by the patient's condition. Patients with mild complications who are taking only standard medications may need to be seen only 1 month after the initial visit and then 6 months and 12 months later. Patients with more serious conditions who qualify for VIG or placebo treatments may be seen daily for a week, then once a week for the rest of the first month, and then at 6 months and 12 months, unless more frequent treatment or observation is required.
NCT01867866 ↗	Study Comparing the Pharmacokinetics of FTD as a Component of TAS-102 With FTD Alone	Completed	Taiho Oncology, Inc.	Phase 1	2013-05-01	The purpose of this study is to compare the pharmacokinetics of trifluorothymidine (FTD) as a component of TAS-102 with FTD alone.

Clinical Trial Conditions for trifluridine

Condition Name

Condition Name for trifluridine
Intervention	Trials
Metastatic Colorectal Cancer	22
Colorectal Cancer	11
Stage IV Colorectal Cancer AJCC v8	7
Stage IVC Colorectal Cancer AJCC v8	6

Condition MeSH

Condition MeSH for trifluridine
Intervention	Trials
Colorectal Neoplasms	63
Adenocarcinoma	17
Colonic Neoplasms	9
Carcinoma	9

Clinical Trial Locations for trifluridine

Trials by Country

Trials by Country for trifluridine
Location	Trials
United States	162
China	48
Italy	28
Japan	23
Australia	16

Trials by US State

Trials by US State for trifluridine
Location	Trials
Texas	15
California	15
Florida	11
Illinois	9
Arizona	8

Clinical Trial Progress for trifluridine

Clinical Trial Phase

Clinical Trial Phase for trifluridine
Clinical Trial Phase	Trials
PHASE3	5
PHASE2	24
PHASE1	7

Clinical Trial Status

Clinical Trial Status for trifluridine
Clinical Trial Phase	Trials
RECRUITING	51
Not yet recruiting	15
NOT_YET_RECRUITING	12

Clinical Trial Sponsors for trifluridine

Sponsor Name

Sponsor Name for trifluridine
Sponsor	Trials
National Cancer Institute (NCI)	15
Servier	6
Taiho Oncology, Inc.	5

Sponsor Type

Sponsor Type for trifluridine
Sponsor	Trials
Other	102
Industry	46
NIH	18

Trifluridine Clinical Trials Update, Market Analysis, and FDA/Patent Projection Through 2030

Last updated: July 27, 2026

Trifluridine (commonly in combination with tipiracil as trifluridine/tipiracil for oncology) has ongoing development activity across colorectal and other solid tumors and continued label and lifecycle work via combination regimens and dosing/formulation refinements. Near-term commercialization is anchored by existing approved oncology use, while longer-term value capture depends on (1) expansion in colorectal cancer settings and (2) whether later-line and combination strategies translate into durable overall survival and treatment persistence. For exclusivity and generic/biosimilar risk assessment, trifluridine itself is not a biologic; the market risk is driven by small-molecule patent estates, formulation/method patents, and any FDA Paragraph IV filings against the listed reference product(s).

What is trifluridine and where is it approved?

Trifluridine is an oral nucleoside analog antineoplastic. In practice, most market access and prescribing use in the US is tied to the combination trifluridine/tipiracil (brand: Lonsurf) for metastatic colorectal cancer and other approved colorectal indications, depending on jurisdiction and line of therapy.

What FDA approvals drive commercialization?

Commercial demand for trifluridine products is dominated by:

• Approved indications for metastatic colorectal cancer (mCRC).
• Treatment-line positioning (later line versus earlier combination strategies).
• Retention on payer formularies driven by clinical outcomes in refractory populations.

How does trifluridine compare with other oral oncology agents?

Relative market structure is shaped by:

• Oral small-molecule category competition (single-agent cytotoxics and kinase inhibitors).
• High competition from targeted agents in earlier lines versus nucleoside analogs’ role in later lines.
• Distinct payer adoption patterns due to toxicity profiles and expected survival benefit magnitude in refractory populations.

What clinical trials are actively updating for trifluridine?

A trifluridine “clinical trials update” is typically dominated by:

• Phase 2/3 combination trials with other cytotoxics and targeted agents.
• Studies in earlier lines or new biomarker-defined subgroups.
• Trials evaluating dosing schedules, adherence support, or safety management.

Which trial designs most affect market projections?

The trials most likely to change market size are those that:

• Move into earlier-line settings (before refractoriness).
• Demonstrate statistically significant overall survival and durable response or improved disease control.
• Show a manageable safety profile that supports combination uptake.

What outcomes in trial updates matter most commercially?

Commercially material readouts for trifluridine are:

• Overall survival and progression-free survival in intent-to-treat populations.
• Objective response rate where mechanistically relevant.
• Treatment discontinuation rates and dose intensity, because adherence affects real-world persistence.
• Subgroup performance, especially in microsatellite instability, RAS/BRAF status, and prior exposure patterns (when studied and reported).

What is the current market size and near-term demand outlook for trifluridine?

Near-term market demand is best modeled as a function of:

• Treated patient volumes in late-line mCRC.
• Competitive dynamics with other later-line options.
• Brand persistence and payer coverage stability.
• Price and reimbursement pressure.

What drives trifluridine adoption in oncology?

Adoption drivers in later-line colorectal cancer include:

• Demonstrated survival benefit in refractory disease populations.
• Familiar administration protocols for clinicians and oncology clinics.
• Payer willingness where clinical benefit is clear in heavily pretreated populations.

What could reduce demand?

Key downside drivers include:

• Evidence that combinations increase toxicity without clear survival gains.
• Loss of exclusivity-related pressure if generic entry accelerates and payer behavior shifts.
• Competitors with stronger efficacy in similar lines displacing use.

How will trifluridine market share evolve by 2026-2030?

Market share evolution depends on whether trifluridine captures earlier lines and combination protocols.

• If new combination regimens gain approvals, addressable populations expand, improving volume and share.
• If results remain confined to later lines, growth is primarily incremental and constrained by incidence and refractory treatment pathways.

Scenario model (directional, basis-weighted)

• Base case: modest growth driven by label maintenance and incremental combination adoption.
• Upside case: successful phase 3 expansions and new partner regimens lead to earlier-line uptake.
• Downside case: limited incremental evidence outside current settings plus growing alternative later-line utilization.

When does trifluridine lose exclusivity, and what are the key expiration dates?

Exclusivity and patent “loss of exclusivity” for trifluridine products are governed by:

• Patent term for the reference-listed drug(s) associated with trifluridine/tipiracil.
• Formulation patents covering specific oral dosing forms and stability/safety improvements.
• Method-of-use patents tied to specific indications, line-of-therapy, and combination regimens.

What are the practical exclusivity gates for generic entry?

Generic entry risk typically depends on:

• Whether unexpired Orange Book patents remain for the relevant NDA strength and dosage form.
• Whether any Paragraph IV challenges are filed and resolved.
• Whether patent-specific carve-outs exist for certain strengths or regimen constraints.

Where does biosimilar risk fit?

Trifluridine is a small molecule, so biosimilar frameworks do not apply. The risk is generic small-molecule entry and paragraph IV litigation, not biosimilar interchangeability.

What patents protect trifluridine products (and how are they typically structured)?

A patent estate for trifluridine-based oncology therapy usually includes:

• Active ingredient-related patents (core compound and prodrug-related claims).
• Formulation patents (tablet composition, film-coating, stability, excipients).
• Manufacturing method patents (process controls, granulation, tablet pressing, coating steps).
• Method-of-use patents (dose regimen, combination with other agents, lines of therapy).

Which jurisdictions matter?

Market decisions and litigation strategy concentrate on:

• United States (Orange Book and Hatch-Waxman framework).
• EU and UK (national validation and EPO granted patents).
• Japan and other major oncology markets, depending on commercial footprint.

What is the Orange Book status of trifluridine (and what patents block generics)?

Orange Book status determines which patents are listed as blocking for generic substitution for specific dosage forms. Key question for market entrants:

• Which Orange Book-listed patents remain unexpired for the specific strength and dosage form that a generic would seek to reference.

How to interpret Orange Book listings for entry timing

• The more listed patents remain active for the exact product configuration, the slower generic entry.
• If only formulation or method-of-use patents remain, generics may still face design-around or carve-out routes depending on claims and litigation outcomes.

What Paragraph IV challenges exist for trifluridine products?

Paragraph IV challenges signal that a generic challenger expects to launch before patent expiration. A complete “clinical trials update” plus “market analysis and projection” requires tying demand to legal timing:

• Any active Paragraph IV litigation can delay generic entry through stays or injunctions.
• Settlements can set “at-risk” launch dates or carve-outs.

What settlement structures are common in Hatch-Waxman

Common outcome patterns:

• 30-month stay until resolution (if triggered).
• Settlement with agreed launch date(s).
• Payment-for-delay structures in some cases, with public settlement terms affecting launch projections.

What generic entry risks exist for trifluridine through 2030?

Generic entry risk is driven by:

• The maturity of the core patent estate.
• Whether method-of-use patents are enforceable for the exact indication and regimen.
• Whether formulation patents can be designed around without infringing.
• Litigation duration and whether courts uphold key claims.

How does launch at first possible date versus design-around affect market projection?

Market share impact usually follows:

• Fast uptake after launch when payer coverage is supportive.
• Slower uptake when bioequivalence and formulation substitutions face clinician resistance.
• Lower erosion if brand retains adherence support and patient switching barriers.

Which companies are developing trifluridine combinations, and what is the competitive landscape?

The competitive landscape in later-line colorectal oncology is crowded by:

• Other oral cytotoxics and combination regimens.
• Targeted therapies and immunotherapy in biomarker-selected populations.
• Novel agents that may shift standard of care earlier or reduce time on nucleoside analogs.

How do competitor trial results affect trifluridine projections?

Trifluridine volume sensitivity is highest when:

• Competitors outperform on overall survival in similar lines.
• Competitors show better safety enabling higher intensity and persistence.
• Payers shift formularies based on incremental survival and toxicity data.

How strong is the patent estate for trifluridine in the US versus Europe?

Patent strength impacts both:

• Generic entry timing.
• Litigation leverage in settlement negotiations.

What typically increases patent estate strength?

• Overlapping claims with broad independent coverage for compound and composition.
• Validity defenses supported by prosecution history.
• Multiple enforceable jurisdictions with similar claim language.

What reduces patent estate strength?

• Narrow claim scope dependent on specific dosing or excipient lists.
• Claims weakened by prior art or claim amendments.
• Regional differences where key claims are not validated or are revoked.

What formulations are protected, and does the product change matter for entry?

Even with active patents, generics may pursue:

• Different excipient compositions.
• Different film coatings or manufacturing routes.
• Strength-specific challenges tied to listed Orange Book entries.

Dosage form and strength specificity

Projection quality depends on whether generics intend to launch:

• The same strength as the reference NDA.
• All strengths simultaneously or selectively.

What method-of-use patents matter for clinical uptake and litigation?

Method-of-use claims tie patent rights to:

• Specific indications (eg, refractory mCRC).
• Specific dosing regimens and treatment lines.
• Specific combinations with partner therapies.

Litigation and clinical uptake

If method-of-use claims remain enforceable:

• Generics may face restrictions on labeling and promotional claims.
• Clinician switching patterns may slow if generic labeling is narrower.

How does trifluridine compare with trifluridine/tipiracil and other late-line mCRC options?

Market framing in practice is:

• Trifluridine’s commercial value is largely realized via the combination drug ecosystem.
• Comparative outcomes versus other later-line regimens determine formulary retention and switching.

Key comparative axes that shift prescribing

• Overall survival in later-line settings.
• Safety profile and manageable hematologic toxicity.
• Real-world persistence driven by tolerability and dosing schedule burden.

What FDA regulatory milestones could shift timelines?

Regulatory milestones that can impact market projections:

• Supplemental NDA approvals for new combinations.
• Label expansions for earlier lines or biomarker-defined subsets.
• Safety updates that alter dosing or patient selection.

How label changes affect competitive positioning

• Label expansion can increase addressable patient populations.
• Safety-driven label tightening can reduce eligible patient pools or increase monitoring costs for providers.

Clinical trial-to-market timeline: what matters for 2024-2030 projection?

The most predictive timeline link is:

• Phase 3 primary endpoint readouts and confirmatory submission windows.
• FDA review cycles and potential priority review designations.
• Approval-to-launch logistics and formulary coverage timelines.

Projection drivers by year band

• 2024-2026: continued optimization of combination evidence and adoption of any new regimens.
• 2026-2028: potential label expansions if late-stage data are positive; major competitive shifts if key alternatives secure stronger outcomes.
• 2028-2030: increased sensitivity to exclusivity end dates and generic entry risk.

Key tables for decision-making

Trifluridine (trifluridine/tipiracil) decision table

Topic	What to check	Why it matters for projections
Clinical pipeline	Phase 2/3 combination readouts, endpoints	Determines label expansion and earlier-line growth
Exclusivity	Orange Book listed patents remaining	Sets generic launch floor
Litigation	Paragraph IV filings and settlement dates	Controls timing of erosion
Formulation specificity	strength and dosage form patent coverage	Determines design-around feasibility
Real-world uptake	persistence, dose intensity, discontinuation	Determines whether clinical benefit converts to revenue

US market erosion sensitivity (generic entry mechanics)

Event	Typical market effect	Timeline impact
Launch of first generic	price pressure, switching at payer level	immediate volume loss risk
Indicated carve-outs	slower clinician adoption	partial protection of volume
Patent litigation delay	brand persistence	pushes erosion out

Key Takeaways

• Trifluridine’s market trajectory is anchored by later-line colorectal cancer adoption and depends on whether combination or earlier-line evidence leads to label expansion.
• Competitive displacement risk is highest when alternatives secure superior overall survival in similar treatment lines.
• Generic entry risk is driven by Orange Book patent listings for the specific trifluridine/tipiracil reference product(s), plus Paragraph IV litigation and settlement timing.
• Market projection through 2030 should be built around two moving parts: (1) late-stage clinical outcomes that can expand the addressable population and (2) the legal timetable that governs erosion.

FAQs

1. What is the difference between trifluridine and trifluridine/tipiracil (tipiracil role in the regimen)?
2. How do Paragraph IV patent challenges affect generic launch timing for trifluridine products?
3. Which clinical endpoints for trifluridine combinations best predict label expansion?
4. What Orange Book patent types (compound, formulation, method-of-use) most often block generic substitution?
5. How does dosing schedule and toxicity management influence real-world persistence for trifluridine/tipiracil?

References

1. FDA Orange Book. Approved Drug Products with Therapeutic Equivalence Evaluations (Orange Book). U.S. FDA.
2. FDA Drug Trials Snapshots. U.S. FDA.
3. ClinicalTrials.gov. Trifluridine and trifluridine combination studies.