Sequencing beyond the second-line setting in metastatic colorectal cancer

Axel Grothey, John L. Marshall, Tanios Bekaii-Saab

Research output: Contribution to journalArticle

Abstract

The standard treatment for patients with metastatic colorectal cancer (mCRC) in the first- and second-line setting is generally chemotherapy, which can be augmented with vascular endothelial growth factor-targeted therapies and, for patients with KRAS wild-type status, epidermal growth factor receptor-targeted therapies. However, nearly all patients ultimately develop disease progression and require later lines of therapy. Traditionally, physicians recycled chemotherapy in the later lines, with many patients showing diminished or no response. However, the past several years have seen the introduction of 2 agents for patients with refractory mCRC entering the third-line setting. The multitargeted tyrosine kinase inhibitor regorafenib and the cytotoxic combination of trifluridine/tipiracil have demonstrated significant improvements in overall survival in patients with refractory mCRC. Although these agents do not seem to induce complete responses, they can lead to durable stable disease. Regorafenib and trifluridine/tipiracil differ in their safety profiles. Physicians and patients must be properly educated on how to recognize and mitigate adverse events. For regorafenib, a dose-escalating strategy improves tolerability without impacting efficacy. When sequencing these agents, physicians should consider patient characteristics, including comorbidities, prior adverse reactions to treatments, and overall performance status. Ongoing studies are further defining the role of regorafenib and trifluridine/tipiracil in the treatment of mCRC.

Original languageEnglish (US)
Pages (from-to)1-19
Number of pages19
JournalClinical advances in hematology & oncology : H&O
Volume17
Issue number3
StatePublished - Mar 1 2019

Fingerprint

Colorectal Neoplasms
Trifluridine
Physicians
Therapeutics
Drug Therapy
Proxy
Epidermal Growth Factor Receptor
Protein-Tyrosine Kinases
Vascular Endothelial Growth Factor A
Disease Progression
Comorbidity
Safety
Survival
regorafenib

ASJC Scopus subject areas

  • Hematology
  • Oncology

Cite this

Sequencing beyond the second-line setting in metastatic colorectal cancer. / Grothey, Axel; Marshall, John L.; Bekaii-Saab, Tanios.

In: Clinical advances in hematology & oncology : H&O, Vol. 17, No. 3, 01.03.2019, p. 1-19.

Research output: Contribution to journalArticle

@article{f6623817c6a843449fe8a1c07fb603df,
title = "Sequencing beyond the second-line setting in metastatic colorectal cancer",
abstract = "The standard treatment for patients with metastatic colorectal cancer (mCRC) in the first- and second-line setting is generally chemotherapy, which can be augmented with vascular endothelial growth factor-targeted therapies and, for patients with KRAS wild-type status, epidermal growth factor receptor-targeted therapies. However, nearly all patients ultimately develop disease progression and require later lines of therapy. Traditionally, physicians recycled chemotherapy in the later lines, with many patients showing diminished or no response. However, the past several years have seen the introduction of 2 agents for patients with refractory mCRC entering the third-line setting. The multitargeted tyrosine kinase inhibitor regorafenib and the cytotoxic combination of trifluridine/tipiracil have demonstrated significant improvements in overall survival in patients with refractory mCRC. Although these agents do not seem to induce complete responses, they can lead to durable stable disease. Regorafenib and trifluridine/tipiracil differ in their safety profiles. Physicians and patients must be properly educated on how to recognize and mitigate adverse events. For regorafenib, a dose-escalating strategy improves tolerability without impacting efficacy. When sequencing these agents, physicians should consider patient characteristics, including comorbidities, prior adverse reactions to treatments, and overall performance status. Ongoing studies are further defining the role of regorafenib and trifluridine/tipiracil in the treatment of mCRC.",
author = "Axel Grothey and Marshall, {John L.} and Tanios Bekaii-Saab",
year = "2019",
month = "3",
day = "1",
language = "English (US)",
volume = "17",
pages = "1--19",
journal = "Clinical Advances in Hematology and Oncology",
issn = "1543-0790",
publisher = "Millennium Medical Publishing, Inc.",
number = "3",

}

TY - JOUR

T1 - Sequencing beyond the second-line setting in metastatic colorectal cancer

AU - Grothey, Axel

AU - Marshall, John L.

AU - Bekaii-Saab, Tanios

PY - 2019/3/1

Y1 - 2019/3/1

N2 - The standard treatment for patients with metastatic colorectal cancer (mCRC) in the first- and second-line setting is generally chemotherapy, which can be augmented with vascular endothelial growth factor-targeted therapies and, for patients with KRAS wild-type status, epidermal growth factor receptor-targeted therapies. However, nearly all patients ultimately develop disease progression and require later lines of therapy. Traditionally, physicians recycled chemotherapy in the later lines, with many patients showing diminished or no response. However, the past several years have seen the introduction of 2 agents for patients with refractory mCRC entering the third-line setting. The multitargeted tyrosine kinase inhibitor regorafenib and the cytotoxic combination of trifluridine/tipiracil have demonstrated significant improvements in overall survival in patients with refractory mCRC. Although these agents do not seem to induce complete responses, they can lead to durable stable disease. Regorafenib and trifluridine/tipiracil differ in their safety profiles. Physicians and patients must be properly educated on how to recognize and mitigate adverse events. For regorafenib, a dose-escalating strategy improves tolerability without impacting efficacy. When sequencing these agents, physicians should consider patient characteristics, including comorbidities, prior adverse reactions to treatments, and overall performance status. Ongoing studies are further defining the role of regorafenib and trifluridine/tipiracil in the treatment of mCRC.

AB - The standard treatment for patients with metastatic colorectal cancer (mCRC) in the first- and second-line setting is generally chemotherapy, which can be augmented with vascular endothelial growth factor-targeted therapies and, for patients with KRAS wild-type status, epidermal growth factor receptor-targeted therapies. However, nearly all patients ultimately develop disease progression and require later lines of therapy. Traditionally, physicians recycled chemotherapy in the later lines, with many patients showing diminished or no response. However, the past several years have seen the introduction of 2 agents for patients with refractory mCRC entering the third-line setting. The multitargeted tyrosine kinase inhibitor regorafenib and the cytotoxic combination of trifluridine/tipiracil have demonstrated significant improvements in overall survival in patients with refractory mCRC. Although these agents do not seem to induce complete responses, they can lead to durable stable disease. Regorafenib and trifluridine/tipiracil differ in their safety profiles. Physicians and patients must be properly educated on how to recognize and mitigate adverse events. For regorafenib, a dose-escalating strategy improves tolerability without impacting efficacy. When sequencing these agents, physicians should consider patient characteristics, including comorbidities, prior adverse reactions to treatments, and overall performance status. Ongoing studies are further defining the role of regorafenib and trifluridine/tipiracil in the treatment of mCRC.

UR - http://www.scopus.com/inward/record.url?scp=85075067152&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85075067152&partnerID=8YFLogxK

M3 - Article

C2 - 31730588

AN - SCOPUS:85075067152

VL - 17

SP - 1

EP - 19

JO - Clinical Advances in Hematology and Oncology

JF - Clinical Advances in Hematology and Oncology

SN - 1543-0790

IS - 3

ER -