Targeted Therapy Options Sometimes Underutilized in Metastatic CRC
John L. Marshall, MD, discusses the sequencing of targeted therapy for refractory metastatic colorectal cancer.
John L. Marshall, MD, director of the Ruesch Center for the Cure of Gastrointestinal Cancers at Georgetown Lombardi Comprehensive Cancer Center in Washington, DC, discusses the sequencing of targeted therapy for refractory metastatic colorectal cancer (CRC).
The addition of bevacizumab (Avastin) to trifluridine/tipiracil (Lonsurf) was approved in 2023 based on the SUNLIGHT trial (NCT04737187). At the same time, a new drug, fruquintinib (Fruzaqla) was approved based on the FRESCO-2 trial (NCT04322539). Between these 2 newer options and regorafenib (Stivarga), none have been investigated in comparison to one another, which Marshall says has led to uncertainty on which should be used before the others in sequence.
However, there is a surprising number of patients who do not receive all 3 options, considering that each has a different mechanism of action and could all have efficacy in the same patient, according to Marshall. Although he tends to use trifluridine/tipiracil plus bevacizumab earliest based on the SUNLIGHT data, and then use fruquintinib and regorafenib after progression, any of them could be a reasonable option. It is important for physicians to consider patients for multiple lines provided they can tolerate therapy.
TRANSCRIPTION:
0:10 | At the same time this was happening, we also had the new drug fruquintinib coming along, and we already had regorafenib. So, there is some jockeying...for what would you try first, second, or third. What shocks me on some level is the number of patients who don't end up having all 3 choices, because they're different and they work in different ways. My bias tends to be using the [trifluridine/tipiracil]/bevacizumab in those patients early on and then saving fruquintinib and regorafenib for later. In my opinion, I think the positive data from SUNLIGHT give you good enough validation that this is a reasonable choice in that window earlier on, but I would not fault a physician for using regorafenib or fruquintinib earlier as well. The main point is, don't leave these drugs on the table.
