1
|
Wang Y, Xu J, Dong M, Liu K, Lu Y, Chen K, Cao Y, Shi H, Bei Y, Li J, Zhao J, Cao Y, Lu N, Yang L, Liu H, Cai P, Li K, Yang T, He N, Dong J, Zhang C. Fruquintinib in metastatic colorectal cancer: a multicenter real-world analysis on efficacy, safety, and predictive and prognostic factors. J Gastrointest Oncol 2024; 15:1519-1533. [PMID: 39279967 PMCID: PMC11399836 DOI: 10.21037/jgo-24-559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Accepted: 08/19/2024] [Indexed: 09/18/2024] Open
Abstract
Background Randomized trials have shown a survival benefit for fruquintinib over placebo in patients with metastatic colorectal cancer (mCRC) that progressed after standard therapies, but real-world prognostic analyses have been seldom reported. We evaluated survival, safety outcomes, and predictive and prognostic factors in patients treated with fruquintinib in a real-life setting. Methods We conducted a multi-center study by collecting relevant data on patients with advanced colorectal cancer (CRC) who received fruquintinib, focusing on progression-free survival (PFS), overall survival (OS), and L3 skeletal muscle index (SMI), including safety follow-up. Results From January 2020 to January 2022, a total of 140 patients were selected and included in this study. The cut-off date was 30 July 2022. The median follow-up time was 18.3 months (range, 6-29.3 months) and the median age of included cases was 63 years (range, 32-81 years). The median PFS and OS for the 140 patients was 6.3 and 12.6 months, respectively. The median PFS and OS for the 76 patients who were included in SMI analysis was 6.0 and 12.0 months, respectively. Multivariate analysis suggested brain metastasis {hazard ratio (HR) [95% confidence interval (CI)]: 2.779 (1.162-6.646), P=0.02}, decrease in SMI of >5% [HR (95% CI): 9.732 (2.201-43.028), P=0.003], and baseline carcinoembryonic antigen (CEA) level [HR (95% CI): 4.061 (1.391-11.858), P=0.01] as independent predictors of OS. The most common treatment-related adverse events (TRAEs) were hypertension (24, 17.1%), fatigue (21, 15%), and hand-foot syndrome (20, 14.3%); 9 (13.6%) and 15 (10.7%) patients had dose reduction and treatment discontinuation due to TRAEs respectively. Conclusions The real-world efficacy and safety of fruquintinib in advanced CRC patients are numerically superior to that in the previous phase III studies. SMI, brain metastasis and CEA could serve as potential markers for patient selection.
Collapse
Affiliation(s)
- Yi Wang
- Department of Radiotherapy and Chemotherapy, Ningbo No. 2 Hospital, Ningbo, China
| | - Jianfen Xu
- Department of Medical Oncology, Ningbo No. 2 Hospital, Ningbo, China
| | - Mingjun Dong
- Department of Anus & Intestine Surgery, Ningbo No. 2 Hospital, Ningbo, China
| | - Kaitai Liu
- Department of Radiation Oncology, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
| | - Yi Lu
- Department of Radiation Oncology, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Ke Chen
- Department of Radio Chemotherapy, The Affiliated People's Hospital of Ningbo University, Ningbo, China
| | - Yuepeng Cao
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Hang Shi
- Department of Oncology, Ningbo Municipal Hospital of Traditional Chinese Medicine, Affiliated Hospital of Zhejiang Chinese Medical University, Ningbo, China
| | - Yanping Bei
- Department of Radiation Oncology, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Jianjiong Li
- Department of Anorectal Surgery, Ningbo No. 2 Hospital, Ningbo, China
| | - Jianpei Zhao
- Department of Colorectal Surgery, Ningbo No. 2 Hospital, Ningbo, China
| | - Yisheng Cao
- Department of Colorectal Surgery, Ningbo No. 2 Hospital, Ningbo, China
| | - Ning Lu
- Department of Oncology, Ningbo Municipal Hospital of Traditional Chinese Medicine, Affiliated Hospital of Zhejiang Chinese Medical University, Ningbo, China
| | - Lu Yang
- Department of Radiotherapy and Chemotherapy, Ningbo No. 2 Hospital, Ningbo, China
| | - Haizhong Liu
- Hepatobiliary and Pancreatic Surgery Department, Ningbo No. 2 Hospital, Ningbo, China
| | - Ping Cai
- Department of Colorectal Surgery, Ningbo No. 2 Hospital, Ningbo, China
| | - Kai Li
- Department of Radiotherapy and Chemotherapy, Ningbo No. 2 Hospital, Ningbo, China
| | - Tong Yang
- Tumor HIFU Department, Ningbo No. 2 Hospital, Ningbo, China
| | - Ning He
- Tumor HIFU Department, Ningbo No. 2 Hospital, Ningbo, China
| | - Jing Dong
- Department of Oncology, Ningbo Municipal Hospital of Traditional Chinese Medicine, Affiliated Hospital of Zhejiang Chinese Medical University, Ningbo, China
| | - Chen Zhang
- Department of Radiotherapy and Chemotherapy, Ningbo No. 2 Hospital, Ningbo, China
| |
Collapse
|
2
|
Patell K, Mears VL, Storandt MH, Mahipal A. Metabolism, toxicity and management of fruquintinib: a novel drug for metastatic colorectal cancer. Expert Opin Drug Metab Toxicol 2024; 20:197-205. [PMID: 38497279 DOI: 10.1080/17425255.2024.2332364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/15/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Colorectal cancer (CRC) is the third most diagnosed cancer globally and despite therapeutic strides, the prognosis for patients with metastatic disease (mCRC) remains poor. Fruquintinib is an oral vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor (TKI) targeting VEGFR -1, -2, and -3, and has recently received approval by the U.S. Food and Drug Administration for treatment of mCRC refractory to standard chemotherapy, anti-VEGF therapy, and anti-epidermal growth factor receptor (EGFR) therapy. AREAS COVERED This article provides an overview of the pre-clinical data, pharmacokinetics, clinical efficacy, and safety profile of fruquintinib, as well as the management of clinical toxicities associated with fruquintinib. EXPERT OPINION Fruquintinib is a valuable additional treatment option for patients with refractory mCRC. The pivotal role of vigilant toxicity management cannot be understated. While fruquintinib offers a convenient and overall, well-tolerated treatment option, ongoing research is essential to determine its efficacy in different patient subsets, evaluate it in combination with chemotherapy and immunotherapy, and determine its role in earlier lines of therapy.
Collapse
Affiliation(s)
- Kanchi Patell
- Hematology and Oncology Fellow, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Veronica Lee Mears
- GI Oncology Clinical Pharmacist Specialist, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | | | - Amit Mahipal
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
3
|
Yang X, Yin X, Qu X, Guo G, Zeng Y, Liu W, Jagielski M, Liu Z, Zhou H. Efficacy, safety, and predictors of fruquintinib plus anti-programmed death receptor-1 (PD-1) antibody in refractory microsatellite stable metastatic colorectal cancer in a real-world setting: a retrospective cohort study. J Gastrointest Oncol 2023; 14:2425-2435. [PMID: 38196544 PMCID: PMC10772700 DOI: 10.21037/jgo-23-931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024] Open
Abstract
Background Patients with microsatellite stable (MSS) advanced colorectal cancer (CRC) have few alternatives for salvage therapy and a large unmet clinical need. Preclinical studies demonstrate that fruquintinib combined with anti-programmed death protein 1 (PD-1) has a synergistic anti-tumor effect. But a few phase 2 clinical studies show inconsistent efficacy of this combination therapy in CRC. The aim of this study was to investigate the efficacy, safety, and predictors of fruquintinib plus PD-1 antibodies in refractory MSS metastatic CRC (mCRC) in a real-world setting. Methods We performed a retrospective single-center analysis to assess the outcomes of patients with MSS mCRC who were treated with fruquintinib plus anti-PD-1 antibodies subsequent to the failure of standard therapies at the Hunan Cancer Hospital. The overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and toxicity were reviewed and evaluated. The primary endpoint was OS. The impact on OS and PFS was examined using the Cox regression model. Results Between 1 January 2019 and 30 June 2022, we enrolled 70 eligible patients. The median follow-up was 17.2 months (range, 5.3-32.9 months). The median OS (mOS) and median PFS (mPFS) were 19.48 and 5.5 months respectively. The ORR was 11.43% and the DCR was 84.29%. Multivariate Cox regression analysis reveals liver metastasis (LM) without local treatment was a risk factor for OS [hazard ratio (HR) =5.31, P=0.0184], whereas that with local treatment (HR =2.19, P=0.263) was not. The most common adverse events were hand-foot syndrome (37.14%), hypertension (34.29%), mucositis oral (32.86%). No serious adverse effects or adverse effect-related deaths were reported. There were no instances of severe adverse effects or deaths related to adverse effects reported. Conclusions Our study indicates that the combination of fruquintinib and anti-PD-1 antibodies can improve the OS and PFS with a tolerable toxicity profile for Chinese patients with refractory MSS mCRC. LM without local therapy is a negative prognostic factor for OS, but those with local treatment can significantly prolong survival. We require additional well-structured, prospective, and extensive studies to confirm and validate these findings.
Collapse
Affiliation(s)
- Xiaolin Yang
- Department of Gastroenterology and Urology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xianli Yin
- Department of Gastroenterology and Urology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xiaozhou Qu
- Department of Gastroenterology and Urology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Geyang Guo
- Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yidong Zeng
- Department of Gastroenterology and Urology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Wu Liu
- Department of Gastroenterology and Urology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Mateusz Jagielski
- Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum Nicolaus Copernicus University, Toruń, Poland
| | - Zhenyang Liu
- Department of Gastroenterology and Urology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Huijun Zhou
- Department of Gastroenterology and Urology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| |
Collapse
|