scholarly journals Practical considerations in the use of regorafenib in metastatic colorectal cancer

2020 ◽  
Vol 12 ◽  
pp. 175883592095686
Author(s):  
Fotios Loupakis ◽  
Lorenzo Antonuzzo ◽  
Jean-Baptiste Bachet ◽  
Feng-Che Kuan ◽  
Teresa Macarulla ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Decision Making ◽  
Metastatic Colorectal Cancer ◽  
Treatment Options ◽  
Daily Practice ◽  
The Third ◽  
Appropriate Treatment ◽  
Third Line ◽  
Line Setting ◽  
Physician Patient

Over the past 20 years, management of patients with metastatic colorectal cancer (mCRC) has improved considerably, leading to increased overall survival and more patients eligible for third- or later-line therapy. Currently, two oral therapies are recommended in the third-line treatment of mCRC, regorafenib and trifluridine/tipiracil. Selecting the most appropriate treatment in the third-line setting poses different challenges compared with treatment selection at earlier stages. Therefore, it is important for physicians to understand and differentiate between available treatment options and to communicate the benefits and challenges of these to patients. In this narrative review, practical information on regorafenib is provided to aid physicians in their decision-making and patient communications in daily practice. We discuss the importance of appropriate patient selection and adverse events management through close patient monitoring and dose adjustments to ensure patients stay on treatment for longer and receive as much benefit as possible. We also highlight key physician–patient communication points to facilitate shared decision-making.

scholarly journals Patterns of practice with third-line anti-EGFR antibody for metastatic colorectal cancer

2016 ◽  
Vol 23 (5) ◽  
pp. 329 ◽  
Author(s):  
M.Y. Ho ◽  
D.J. Renouf ◽  
W.Y. Cheung ◽  
H.J. Lim ◽  
C.H. Speers ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Performance Status ◽  
Growth Factor Receptor ◽  
Poor Performance ◽  
Poor Performance Status ◽  
The Third ◽  
Treatment Information ◽  
Third Line ◽  
Line Setting

Background Therapy with anti-epidermal growth factor receptor (egfr) monoclonal antibody improves outcomes for patients with metastatic colorectal cancer (mcrc) in the first-, second-, and third-line trial settings. In British Columbia, the use of egfr inhibitors (egfris) is confined to third-line therapy, which might lower the proportion of patients who receive this therapy. The objective of the present study was to describe egfri treatment patterns when those agents are limited to the third-line setting. The results will inform decisions about optimal use of egfri agents, including earlier in the course of therapy for metastatic disease.Methods All patients with newly diagnosed mcrc who were referred to BC Cancer Agency clinics in 2009 were included in the study. Prognostic and treatment information was prospectively collected; KRAS test results were determined by chart review.Results The study included 443 patients with a median age of 66 years. For the 321 patients who received systemic therapy, median survival was 22.3 months. Of the 117 patients who were treated with 5-fluorouracil, oxaliplatin, and irinotecan, and who were potentially eligible for egfri therapy, 90% (105 patients) were tested for KRAS status. Of the 60 patients with KRAS wild-type tumours, 82% (49 patients) received egfri therapy.Conclusions When egfri therapy is limited to the third-line setting, only a small proportion of patients receive such therapy, with death and poor performance status preventing its use in the rest. Availability of egfri in earlier lines of therapy could increase the proportion of patients treated with all active systemic agents. 

scholarly journals The combination of TAS-102 and bevacizumab as the third line chemotherapy for metastatic colorectal cancer (TAS-CC3 Study)

2018 ◽  
Vol 29 ◽  
pp. viii157
Author(s):  
H. Kamiyama ◽  
Y. Yoshida ◽  
H. Yoshida ◽  
C. Kosugi ◽  
K. Ishibashi ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
The Third ◽  
Third Line ◽  
Line Chemotherapy

A single-arm trial of panitumumab in cetuximab refractory KRAS wild-type colorectal cancer.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 428-428 ◽  
Author(s):  
R. C. Wadlow ◽  
A. F. Hezel ◽  
B. M. Wolpin ◽  
J. N. Allen ◽  
L. S. Blaszkowsky ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Type I Error ◽  
Human Monoclonal Antibody ◽  
Growth Factor Receptor ◽  
Chimeric Antibody ◽  
Type I ◽  
Wild Type ◽  
Third Line ◽  
Line Setting

428 Background: While FOLFOX or FOLFIRI with bevacizumab are the standard first-line regimens in the treatment of metastatic colorectal cancer, a role for epidermal growth factor receptor inhibitiion in KRAS wild-type colorectal cancer has been established in the second and third line setting. Cetuximab is a chimeric antibody that consists of approximately 30% murine protein, and panitumumab is a fully human monoclonal antibody. Correspondingly, the rates of severe hypersensitivity reactions are somewhat increased with cetuximab (3%) compared to panitumumab (1%). Presently, cetuximab is typically used in combination with irinotecan in the second or third line setting, and panitumumab is occasionally substituted if hypersensitivity occurs. The value of panitumumab as a salvage agent in cetuximab-resistant colorectal cancer is unknown. Methods: Panitumumab (6 mg/kg every 14 days) was administered to patients with KRAS wild-type metastatic colorectal cancer that had progressed on prior cetuximab. Treatment was continued until disease progression, death, inability to tolerate panitumumab, or study withdrawal. The primary endpoint was response rate (RR). Twenty patients were enrolled in the first stage and, if at least one responded, 12 additional patients were to be enrolled in a second stage. This two-stage design tested the null hypothesis that the RR is less than or equal to 1% versus greater than or equal to 10% with a type I error of 3.6% and 80% power. Blood samples were collected at baseline and prior to cycles 2 and 3 to evaluate for the presence of anti-cetuximab and anti-panitumumab antibodies using the Biacore immunoassay. Results: 22 patients with ECOG PS 0-2 were treated for a median of two cycles. The best response was stable disease (45%) and the RR was 0%. There were a total of 266 toxicities reported, the majority of which were mild (n = 184, 69%) or moderate (n = 63, 24%) in severity. There were 19 grade 3 and 0 grade 4 toxicities. Median overall survival was 1.9 months. Immunologic data will be reported at the time of presentation. Conclusions: Panitumumab is not active as salvage therapy for patients with cetuximab-resistant, KRAS wild-type metastatic colorectal cancer. [Table: see text]

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