Trifluridine/Tipiracil in Metastatic Colorectal Cancer: A UK Multicenter Real-world Analysis on Efficacy, Safety, Predictive and Prognostic Factors

Chara Stavraka (Lead / Corresponding author), Athanasios Pouptsis, Alicja Synowiec, Vasileios Angelis, Liyana Satterthwaite, Sam Khan, Meera Chauhan, Chloe Holden, Sally Young, Christina Karampera, Maria Martinou, Tina Mills-Baldock, Mark Baxter, Ainsley Barry, Bryony Eccles, Timothy Iveson, Kai-Keen Shiu, Mark Hill, Sherif Abdel-Raouf, Janet Shirley GrahamAnne Thomas, Paul J. Ross

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Abstract

Background: The orally administered combination trifluridine/tipiracil has been approved as third line treatment in mCRC, demonstrating survival benefit and acceptable toxicity profile in the phase III RECOURSE study.

Patient and methods: We performed a multicenter retrospective real-world analysis of patients with mCRC receiving trifluridine/tipiracil between 2016 and 2019 in eight cancer centers across the United Kingdom.

Results: A total of 236 patients were included with median age of 69 years. All patients had received at least 2 lines of fluoropyrimidine-based chemotherapy doublet with oxaliplatin or irinotecan. About 10% of patients had ECOG ≥ 2. Median duration of trifluridine/tipiracil treatment was 3 months with an ORR of 2.1% and disease control rate of 21.6%. Median OS was 7.6 and median PFS 3.3 months. A dose reduction was required in 27% of patients, while 7.6% discontinued treatment due to toxicity. The most common grade 3 toxicities were neutropenia (34%), fatigue (10%), anemia (9%) and febrile neutropenia (5%). Baseline NLR <5 and CEA <200 had favorable prognostic (HR: 0.52 and 0.39, P≤ .001) and predictive value (OR: 4.1 and 6.7, P< .05). Development of grade 3 neutropenia predicted treatment response (OR: 0.32, P< .001). Following treatment with trifluridine/tipiracil 41% were referred for phase I trial or rechallenged with chemotherapy.

Conclusion: Trifluridine/tipiracil is well tolerated in refractory mCRC patients with comparable efficacy and toxicity profile to that of the phase III RECOURSE. Pretreatment NLR and CEA could serve as potential markers for patient selection, while treatment-induced grade 3 neutropenia predicted response. Prospective validation is needed.

Original languageEnglish
Pages (from-to)342-349
Number of pages8
JournalClinical Colorectal Cancer
Volume20
Issue number4
Early online date26 Sep 2021
DOIs
Publication statusPublished - 1 Dec 2021

Keywords

  • Lonsurf
  • Neutropenia
  • Real-world evidence
  • TAS-102
  • Treatment outcomes

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