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Regorafenib or rechallenge chemotherapy: which is more effective in the third-line treatment of metastatic colorectal cancer?

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Abstract

Purpose

To assess the efficacy and safety of regorafenib versus rechallenge chemotherapy in previously treated mCRC patients in third-line setting.

Materials and methods

The data of 104 patients diagnosed with mCRC enrolled from 2010 to 2017 in six oncology centers were analyzed. Tumor treatment options were obtained from follow-up and treatment files. Rechallenge chemotherapy was identified as the re-use of the regimen which was previously administered to patients in one of the therapy lines and obtained disease control, these were the patients whose disease did not progress within 3 months.

Results

A total of 104 patients had received previously two lines of chemotherapy regimens for mCRC. Of these, 73 patients with mCRC who received regorafenib and 31 those who received rechallenge chemotherapy in third-line therapy were analyzed. Overall survival was better with rechallenge than it was with regorafenib (HR 0.29 95% CI 0.16–0.54, p < 0.001). Median OS was 12.0 months (95% CI 8.1–15.9) in rechallenge versus 6.6 months (95% CI 6.0–7.3) in regorafenib group (p < 0.001). Progression-free survival in the rechallenge group showed a higher median value of 9.16 months (95% CI 7.15–11.18) versus with that recorded in the regorafenib group of 3.41 months (95% CI 3.01–3.82), in favor of rechallenge chemotherapy. The most common adverse events of regorafenib was liver function test abnormality and hand–foot syndrome. Although grade 3 or 4 adverse events were similar, non-hematologic toxicities were more common than those of rechallenge.

Conclusions

Rechallenge is still a valuable option against regorafenib in patients who achieved disease control in one of the first two lines of therapy. Even though mCRC patients treated with regorafenib benefited clinically from this treatment, we revealed that chemotherapy rechallenge compared to regorafenib was more effective in the third-line treatment for mCRC patients.

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Authors and Affiliations

  1. Department of Medical Oncology, Trakya University, Edirne, Turkey

    Osman Köstek, Aysun Fatma Doğan, Nazım Can Demircan, Sernaz Uzunoğlu, İrfan Çiçin & Bülent Erdoğan

  2. Clinic of Medical Oncology, Konya Training and Research Hospital, Konya, Turkey

    Muhammet Bekir Hacıoğlu

  3. Okmeydanı Training and Research Hospital, Clinic of Medical Oncology, Istanbul, Turkey

    Abdullah Sakin

  4. Department of Medical Oncology, Bezmi Alem Vakıf University, Istanbul, Turkey

    Tarık Demir

  5. Department of Medical Oncology, Istanbul University, Istanbul, Turkey

    Murat Sarı

  6. Department of Medical Oncology, Sakarya University, Sakarya, Turkey

    Ozlem Ozkul

  7. Department of Medical Oncology, Afyon Kocatepe University, Afyon, Turkey

    Murat Araz

Authors
  1. Osman Köstek
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  2. Muhammet Bekir Hacıoğlu
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  3. Abdullah Sakin
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  4. Tarık Demir
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  7. Murat Araz
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  8. Aysun Fatma Doğan
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  9. Nazım Can Demircan
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  10. Sernaz Uzunoğlu
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  11. İrfan Çiçin
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  12. Bülent Erdoğan
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Corresponding author

Correspondence to Osman Köstek.

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Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Köstek, O., Hacıoğlu, M.B., Sakin, A. et al. Regorafenib or rechallenge chemotherapy: which is more effective in the third-line treatment of metastatic colorectal cancer?. Cancer Chemother Pharmacol 83, 115–122 (2019). https://doi.org/10.1007/s00280-018-3713-6

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  • DOI: https://doi.org/10.1007/s00280-018-3713-6

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