Dr. Grothey on Choosing Between Regorafenib and TAS-102 in mCRC

Axel Grothey, MD, a medical oncologist and director of Gastrointestinal Cancer Research at West Cancer Center and Research Institute, discusses factors to consider when selecting between regorafenib (Stivarga) and trifluridine/tipiracil (TAS-102; Lonsurf) in metastatic colorectal cancer (mCRC).

In the third- and fourth-line settings, regorafenib and TAS-102 have demonstrated modest and comparable response rates for patients with mCRC, Grothey explains. However, the toxicity profiles of these agents have some notable differences that should be considered when selecting between them.

Regorafenib is associated with hand-foot-skin reactions, fatigue, voice changes, and diarrhea, Grothey says. Conversely, neutropenia is the main adverse effect that is associated with TAS-102. 

Many patients receiving TAS-102 require treatment discontinuation following their first cycle of therapy; however, given the coronavirus disease 2019 pandemic, TAS-102 may be the preferred treatment, explains Grothey.

Regorafenib should not be considered for patients with a performance status of 2. However, giving TAS-102 first could deteriorate a patient’s performance status, making them ineligible to receive regorafenib. As such, giving regorafenib first followed by TAS-102 may be the optimal sequencing strategy, concludes Grothey.