Abstract
Outcomes for patients with metastatic colorectal cancer (mcrc) are improving with the introduction of new treatments. Treatment for patients who are still fit after failure of all available therapies represents a significant unmet need. In the present study, we analyzed real-world treatment patterns for patients enrolled in Health Canada's trifluridine/tipiracil (ftd/tpi) Special Access Program (sap) and Taiho Pharma Canada's Patient Support Program (psp). Demographic information and clinical treatment data were collected from adults with mcrc who were previously treated with, or were not candidates for, available therapies and who were enrolled in the sap and psp. For all patients, ftd/tpi treatment status, discontinuation reasons, and prior therapies were examined. The analysis included 717 Canadian patients enrolled in the ftd/tpi sap and psp from September 2017 to October 2018. In that cohort, 59.7% were men, median age was 65 years, and median duration of therapy was 77 days (25%-75% interquartile range: 43-106 days). Of treated patients, 67.1% maintained the same dose for the duration of therapy; 28.0% had a dose reduction.On multivariable analysis, duration of therapy was not influenced by sex, age, province, RAS mutation status, or prior therapies. However, prior oxaliplatin-based chemotherapy (capox or folfox) appeared to be associated with higher rates of discontinuation because of death or disease progression. In advanced mcrc, ftd/tpi is a well-tolerated therapy. The large number of patients enrolled in the access programs within a short period of time is reflective of major clinical need in this area, with many patients being eligible and interested in pursuing treatment in the refractory setting.
Highlights
Outcomes for patients with metastatic colorectal cancer are improving with the introduction of new treatments
The analysis included 717 Canadian patients enrolled in the ftd/tpi sap and psp from September 2017 to October 2018
Treatment for patients with metastatic colorectal cancer is generally palliative and consists of systemic therapies that include chemotherapeutic drugs such as fluoropyrimidines[2,3,4], irinotecan[5,6], and oxaliplatin[7]; angiogenesis inhibitors such as bevacizumab[8,9,10]; and for select patients, monoclonal antibodies such as cetuximab[8] or panitumumab[11]
Summary
Outcomes for patients with metastatic colorectal cancer (mcrc) are improving with the introduction of new treatments. Treatment for patients who are still fit after failure of all available therapies represents a significant unmet need. Treatment for patients with metastatic colorectal cancer (mcrc) is generally palliative and consists of systemic therapies that include chemotherapeutic drugs such as fluoropyrimidines[2,3,4], irinotecan[5,6], and oxaliplatin[7]; angiogenesis inhibitors such as bevacizumab[8,9,10]; and for select patients, monoclonal antibodies such as cetuximab[8] or panitumumab[11]. The new agents available in Canada have significantly improved outcomes for patients with mcrc to more than 33 months[13]. Treatment for patients who are still fit after standard lines of therapy have failed represents a significant unmet need in the clinical management of mcrc. Treatment options in that setting are limited, and no large real-world studies are assessing outcomes of newer agents in clinical practice
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