Place of regorafenib in treatment of patients with metastatic colorectal cancer: when are all options exhausted? Or in third line?

2021 ◽  
pp. 30-35
Author(s):  
A. L. Pylev ◽  
A. A. Zhandarova ◽  
D. S. Romanov ◽  
V. A. Lisovoy
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
World Literature ◽  
Survival Rates ◽  
Maximum Volume ◽  
The Third ◽  
The World ◽  
Metastatic Process ◽  
Third Line ◽  
Line Of Therapy

The use of regorafenib in the treatment of patients with metastatic colorectal cancer divides Russian and foreign oncologists into two camps. Many specialists postpone its appointment until a situation where all other options for systemic therapy have been exhausted, and the physical condition is close to unsatisfactory, and the metastatic process reaches its maximum volume. The position of oncologists adhering to such positions is based on a small number of objective answers and low survival rates without signs of progression of the process, with evidence of a more effective re-prescription of chemotherapy and targeted drugs already used in the treatment of this patient. On the other hand, an analysis of the world literature on regorafenib and options for the third line of therapy for metastatic colorectal cancer shows the ambiguity of the above approach and the potential of the drug in terms of improving the patient’s prospects by overcoming the resistance of the tumor mass to already used drugs and the ability to provide the patient with the so-called chemotherapeutic holiday.

scholarly journals Optimal solutions in the third line therapy for refractory metastatic colorectal cancer. CORRECTness and CONCURency

2021 ◽  
pp. 47-52
Author(s):  
R. T. Ayupov ◽  
A. A. Izmailov ◽  
K. V. Menshikov ◽  
A. V. Sultanbaev ◽  
A. F. Nasretdinov ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Targeted Therapy ◽  
Metastatic Colorectal Cancer ◽  
Kinase Inhibitor ◽  
Survival Rates ◽  
Targeted Drugs ◽  
The Third ◽  
Mutational Status ◽  
Third Line ◽  
Line Of Therapy

Colon cancer therapy currently includes at least 3 cytostatic agents and 6 targeted drugs, combinations of which constitute many different treatment regimens. Nevertheless, as shown by various clinical studies, the use of oxaliplatin, irinotecan and fluoropyrimidine regimens in conjunction with monoclonal targeted drugs remains the main one. After progression on the main lines of therapy and registration of refractory disease, there are not many standard options for treatment in the 3rd line that have statistical confidence in terms of improving survival rates. There have been attempts to search for genetic aberrations for targeted therapy, predictors of the effectiveness of immunotherapy, the use of re-introduction regimens (re-application of a regimen that the patient stopped taking due to intolerance phenomena) and re-challenge (use of previous regimens, with response at first time, and then developed progression), and the abundance of solutions could only be limited by the imagination of the researcher. However, with the advent of the new multi-kinase inhibitor regorafenib, recommendations for the treatment of colorectal cancer have changed. The  drug has received indications for  use in  the  third line of  therapy for  refractory colorectal cancer. A review of the existing options for targeted therapy and an analysis of studies of different regimens in the 3rd line of therapy in  comparison with regorafenib was carried out. It has been established that regorafenib is currently the  optimal option for the treatment of metastatic colorectal cancer in the third line of therapy, regardless of previous lines of therapy and mutational status, and has a satisfactory spectrum of side effects, many of which may be predictors of therapy efficacy. 

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

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.

Cost-effectiveness for metastatic colorectal cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15003-e15003
Author(s):  
Linli Yao ◽  
Jiaqi Han ◽  
Longjiang She ◽  
Dong Ding ◽  
Mengting Liao ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Metastatic Colorectal Cancer ◽  
Cost Effective ◽  
The Third ◽  
Scenario Analyses ◽  
Payer Perspective ◽  
Life Years ◽  
Third Line ◽  
The Cost

e15003 Background: As standard third-line treatments for metastatic colorectal cancer, regorafenib and fruquintinib, compared with placebo, increase median overall survival by 2.5 months and 2.7 months, respectively. Given the incremental clinical benefit, we aim to estimate the cost effectiveness of regorafenib versus fruquintinib in the third-line treatment for patients with metastatic colorectal cancer from Chinese payer perspective. Methods: A mathematical Markov model was established to project the cost-effectiveness of regorafenib versus fruquintinib from the CONCUR and FRESCO clinical trials. Quality-adjusted-life-years (QALYs) were analyzed with extracted data from the trials. Willingness to pay (WTP) of $26508 was used. Drug costs were estimated from the perspectives of the health care system in the People’s Republic of China. One way sensitivity and scenario analyses were performed by varying potentially modifiable parameters of the model. Results: Fruquintinib, compared with regorafenib, provided an additional 0.028 QALYs (0.274 QALYs versus 0.246 QALYs) at less cost ($33536 versus $35607). Conclusions: Fruquintinib is more cost-effective than regorafenib as the third-line management for patients with metastatic colorectal cancer when WTP is $26508.

The use of anti-EGFR monoclonal antibodies-EGFR blockers in the comprehensive treatment of metastatic colorectal cancer with or without the surgical removal of metastases

2016 ◽  
Vol 21 (1-2) ◽  
pp. 66-71
Author(s):  
O. I Kit ◽  
L. Yu Vladimirova ◽  
Nataliya A. Abramova ◽  
A. E Storozhakova ◽  
E. A Kalabanova ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Metastatic Colorectal Cancer ◽  
Progression Free Survival ◽  
Comprehensive Treatment ◽  
Surgical Removal ◽  
Surgical Interventions ◽  
Clinically Significant ◽  
Third Line ◽  
Line Of Therapy

Clinical data on the efficacy and safety of cetuximab and panitumumab in 87 patients in the 1-4 lines of drug therapy for metastatic colorectal cancer (mCRC) with wild-type RAS with and without surgical removal of metastases were analyzed. Anti-EGFR drugs were prescribed for patients in the first line of therapy in 64.4%, in the second line - 14.9%, in the third line - 13.8% and 6.9% - in the fourth line. 14.9% of patients continued anti-EGFR therapy after progression during 2-3 lines (with the change of cytostatics). The use of anti-EGFR drugs in treatment for mCRC was shown to provide satisfactory results of overall survival rate and progression-free survival. The most important result of the analysis is the revealed significant increase in median overall survival from 13.4±1.6 to 18.7±2.3 months (p = 0.04838) in patients who had anti-EGFR therapy and chemotherapy with surgical treatment of distant resectable metastases. Manifestations specific for anti-EGFR drugs dermal toxicity were tolerable and managed with medical correction.Of the patients who has been undergone to cytoreductive surgical interventions for resectable metastases, clinically significant complications of the surgery were observed in 17.2% ofpatients.

Sign in / Sign up

Export Citation Format

Share Document