Impact of tumour growth rate during preceding treatment on tumour response to regorafenib or trifluridine/tipiracil in refractory metastatic colorectal cancer.

Abstract

BACKGROUND:

Although regorafenib (REG) and trifluridine/tipiracil (FTD/TPI) have been recognised as standard treatments in metastatic colorectal cancer (mCRC), the best option remains unclear. Pretreatment tumour growth rate (TGR) is associated with radiotherapeutic efficacy in laryngeal cancer. However, no reports are available on the association between TGR during preceding treatment and the efficacy of REG or FTD/TPI.

PATIENTS AND METHODS:

We retrospectively analysed the data of consecutive mCRC patients treated with REG or FTD/TPI and classified them into slow-growing or rapid-growing (SG or RG) groups according to TGR and emergence of new lesion (NL+) or their absence (NL-) during preceding treatment period [SG: NL- with low TGR (<0.33%/day); RG: NL+ or high TGR (≥0.33%/day)].

RESULTS:

A total of 244 patients (RG/SG, 133/111; REG/FTD/TPI, 132/112) were eligible. The RG proportion with a long duration from first-line chemotherapy and the SG proportion with elevated alkaline phosphatase were higher in REG, whereas the SG proportion with performance status 2 was higher in FTD/TPI. The disease control rates (DCRs) were similar between REG and FTD/TPI (24%/30%; OR: 0.74; p=0.44; adjusted OR: 0.73; p=0.47) in the RG, whereas the DCR was significantly higher for FTD/TPI than for REG (47%/26%; OR: 2.56; p=0.029; adjusted OR: 3.38; p=0.01) in the SG.

CONCLUSIONS:

TGR and NL during preceding treatment may be helpful for drug selection in refractory mCRC patients to be treated with REG or FTD/TPI. However, further studies are needed to confirm the value of TGR for drug selection.

• Authors: Toshiki Masuishi, Hiroya Taniguchi, Takeshi Kawakami, Yasuyuki Kawamoto, Shigenori Kadowaki, Yusuke Onozawa, Tetsuhito Muranaka, Masahiro Tajika, Hirofumi Yasui, Hiroshi Nakatsumi, Satoshi Yuki, Kei Muro, Katsuhiro Omae, Yoshito Komatsu, Kentaro Yamazaki
• Journal: ESMO open (ESMO Open) Vol. 4 Issue 6 (11 2019) ISSN: 2059-7029 [Electronic] England
• PMID: 32392174 (Publication Type: Evaluation Study, Journal Article)
• Copyright: © Author (s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ on behalf of the European Society for Medical Oncology.

Chemical References

• Drug Combinations
• Phenylurea Compounds
• Pyridines
• Pyrrolidines
• trifluridine tipiracil drug combination
• regorafenib
• Uracil
• Thymine
• Trifluridine

Topics

• Aged
• Antineoplastic Combined Chemotherapy Protocols (pharmacology, therapeutic use)
• Clinical Decision-Making (methods)
• Colorectal Neoplasms (drug therapy, mortality, pathology)
• Drug Combinations
• Drug Resistance, Neoplasm (drug effects)
• Female
• Humans
• Male
• Middle Aged
• Phenylurea Compounds (pharmacology, therapeutic use)
• Progression-Free Survival
• Pyridines (pharmacology, therapeutic use)
• Pyrrolidines (pharmacology, therapeutic use)
• Retrospective Studies
• Thymine
• Time Factors
• Trifluridine (pharmacology, therapeutic use)
• Tumor Burden (drug effects)
• Uracil (analogs & derivatives, pharmacology, therapeutic use)