Durable response using regorafenib in an elderly patient with metastatic colorectal cancer: case report

the Cancer Therapy Advisor take:

Regorafenib may provide a reduction in tumor burden and an improvement in quality of life with prolonged survival in elderly patients with KRAS wild-type, refractory metastatic colon cancer, according to a case report published in the journal Cancer Management and Research.

The case report describes a 73-year-old Indian woman who was diagnosed with left-sided stage 3B well-differentiated, KRAS wild-type adenocarcinoma of the colon with 1 of 15 positive lymph nodes.

The patient was first treated with capecitabine, oxaliplatin, and bevacizumab, but developed an anaphylactic reaction during the sixth cycle. She then received capecitabine alone for an additional 2 cycles and had no further evidence of disease on diagnostic imaging.

The patient was then restaged and was found to have metastatic disease in the peritoneum. She received cetuximab plus FOLFIRI (fluorouracil, leucovorin, irinotecan), to which she responded very well.

After no measurable signs of disease and active surveillance, the patient presented with disease progression and was restarted on cetuximab plus FOLFIRI, but achieved a mixed response.

Regorafenib 160 mg orally daily was then initiated; however, the patient developed hypertension and grade 3 fatigue and required treatment interruption.

Treatment was then restarted at 120 mg daily and reduced to 80 mg daily after developing grade 3 fatigue again. Although the patient developed disease progression, she reported improved quality of life without any incidence of side effects.

Introduction

Colorectal cancer (CRC) is one of most common cancers and leading causes of mortality in the USA, accounting for approximately 136,000 new cases and 50,000 deaths per year.¹

For metastatic or unresectable CRC, standard first- and second-line treatments typically involve a combination of cytotoxic chemotherapies (eg, FOLFIRI [5-fluorouracil + oxaliplatin + irinotecan])^2,3 and molecular targeted agents (eg, bevacizumab, cetuximab, panitumumab),^4–6 which can help to improve progressionfree survival and overall survival.

However, due to the nature of the disease, many patients will progress through guideline-recommended standard regimens while maintaining a good performance status. Regorafenib, an oral multikinase inhibitor, which targets angiogenic, stromal, and oncogenic receptor tyrosine kinases, was approved by the US Food and Drug Administration in 2012 for the treatment of patients with metastatic CRC who have been previously treated with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy, an anti–vascular endothelial growth factor (VEGF) therapy and, if KRAS wild-type, an anti–epidermal growth factor receptor (EGFR) therapy.⁷

This approval was based on the CORRECT study, which demonstrated a median overall survival of 6.4 months with regorafenib vs 5.0 months with placebo (hazard ratio, 0.77; 95% confidence interval, 0.64–0.94; P=0.0052).⁸

Among the most common adverse effects were fatigue, hand–foot skin reaction, diarrhea, hypertension, and rash. Here, a case of an elderly patient on regorafenib who achieved stable disease for over 11 months with strategic dose modifications was presented.

Topics:

Colorectal Cancer Gastrointestinal Cancer

Durable response using regorafenib in an elderly patient with metastatic colorectal cancer: case report

the Cancer Therapy Advisor take:

Topics:

Want to read more?

Both RFA, SBRT Effective Local Therapy Options for Inoperable Hepatocelullar Carcinoma

Want to read more?