Colorectal Cancer Treatment: Community Oncologists Favor FTD/TPI + Bevacizumab in Third Line
As treatment options expand for metastatic colorectal cancer (mCRC), a recent survey reveals a growing preference among community-based oncologists for trifluridine-tipiracil (FTD/TPI) plus bevacizumab as a third-line therapy. The findings, published in The Oncologist, highlight the complexities of treatment decisions and the challenges of managing adverse events in this patient population.
The Evolving Landscape of mCRC Treatment
Traditionally, treatment for unresectable mCRC has followed a sequence of fluorouracil-based chemotherapy, anti-VEGF therapies like bevacizumab, and anti-EGFR targeted therapies. However, the introduction of FTD/TPI + bevacizumab has altered the paradigm, particularly in the third-line setting. Clinical trials, including SUNLIGHT, FRESCO-2, and ReDOS, have demonstrated significant survival benefits with this combination, influencing prescribing patterns.
Survey Highlights: Physician Preferences and Considerations
The survey, conducted between October 20, 2024, and December 18, 2024, included 101 community-based physicians. Overall survival (OS) emerged as the primary consideration when selecting a third-line treatment, cited by 40% of respondents, followed by quality of life (22%) and progression-free survival (PFS) (20%). Physicians overwhelmingly considered OS “extremely important” (75%), followed by PFS (59%) and quality of life (51%).
Almost half of the physicians (48%) indicated they “often” prescribe FTD/TPI plus bevacizumab – at least 50% of the time. Capecitabine monotherapy (25%), EGFR combination regimens (25%), regorafenib (24%), and FTD/TPI monotherapy (20%) followed. A majority (60%) identified FTD/TPI plus bevacizumab as their number-one choice in the third line.
Managing Treatment-Related Adverse Events
While FTD/TPI + bevacizumab demonstrates efficacy, managing its side effects is crucial. Survey respondents identified fatigue (25%), neutropenia (23%), and hand-foot syndrome (18%) as the most challenging adverse events to manage. Hand-foot syndrome and allergic reactions were cited as the most likely to lead to treatment discontinuation (both 35%). From the patient’s perspective, hand-foot syndrome (47%), fatigue/weakness/falls (41%), nausea/vomiting (40%), and diarrhea (39%) were considered the most bothersome.
Impact of Clinical Trial Data on Practice
The survey revealed that community physicians are well-informed about recent clinical developments. Respondents reported awareness of trials like SUNLIGHT, FRESCO-2, and ReDOS, and acknowledged that the data had influenced their treatment decisions. This suggests a strong commitment to evidence-based medicine even within community practice settings.
Future Trends and Potential Shifts in mCRC Treatment
The increasing adoption of FTD/TPI + bevacizumab in the third-line setting signals a potential shift in treatment algorithms. As physicians gain more experience with this combination, and as research continues to refine patient selection criteria, its role may expand further. However, the importance of individualized treatment plans, considering patient comorbidities and quality of life, remains paramount.
The survey also highlights the need for improved strategies to manage adverse events. Proactive monitoring, dose adjustments, and supportive care interventions can help mitigate the impact of side effects and optimize treatment outcomes.
Did you realize? FTD/TPI + bevacizumab is now a recommended third-line regimen for mCRC, regardless of RAS mutational status and prior anti-VEGF treatment.
FAQ
Q: What is the preferred third-line treatment for mCRC according to the survey?
A: FTD/TPI plus bevacizumab is the most frequently selected option.
Q: What are the most challenging adverse events associated with FTD/TPI + bevacizumab?
A: Fatigue, neutropenia, and hand-foot syndrome are the most commonly reported challenges.
Q: How are clinical trial results influencing treatment decisions?
A: Physicians report that data from trials like SUNLIGHT, FRESCO-2, and ReDOS have altered their practice.
Q: What factors might prevent a physician from prescribing a certain treatment?
A: Prior therapies given, concerns with potential adverse events, and patient quality of life on other treatment are key considerations.
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