Optimal Dosing of Regorafenib in CRC

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The FDA approved regorafenib in 2012 for use in patients with metastatic CRC who have been previously treated with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy, an anti-VEGF therapy, and, if KRAS wild type, an anti-EGFR therapy. The standard dose for regofenib used in the later-line setting is 160 mg. However, many patients experience toxicities at this dose. In this segment, Cathy Eng, MD, provides practical advice on dosing strategies to help increase the likelihood for success for patients on regorafenib therapy.

Like many of her colleagues, Eng typically starts with a dose of 120 mg of regorafenib; some of her colleagues start as low as 80 mg, she remarks. Because most patients experience early toxicity, within the first 2 months of administration, Eng tends to escalate the dose at first re-staging, as long as the patient tolerates the lower dose.

Eng does not feel that this strategy compromises efficacy. Because the hand-foot skin reaction can be quite challenging for a patient starting therapy with regorafenib, it is important to make sure that the drug is well tolerated before increasing the dose in subsequent cycles of therapy.