SUNLIGHT Regimen in Third-Line mCRC: Insights on Treatment Management and Practical Nuances

Oncologists are increasingly modifying standard dosing protocols for TAS-102 and capecitabine in colorectal cancer (CRC) treatment to improve patient tolerability while maintaining efficacy. The discussion reveals practical approaches including dose reductions, alternative scheduling patterns, and the use of single tablet sizes to minimize dosing errors. Experts emphasize that while maximum tolerated dose is standard in drug development, clinical practice often requires finding the minimum effective dose through individualized patient management.

The panel shares specific dosing modifications including every-other-week scheduling instead of consecutive weeks, rounding down doses, and using body surface area calculators for precision. One expert advocates for a unique 5-days-on, 2-days-off schedule mimicking a work week pattern, monitoring mean corpuscular volume levels as a biomarker for adequate drug exposure. These modifications aim to reduce neutropenia and constitutional symptoms while maintaining treatment adherence and quality of life for patients with advanced colorectal cancer.

Monitoring strategies vary among practitioners, with some checking labs at day 15 of bevacizumab infusions while others focus primarily on neutropenia management rather than thrombocytopenia. The consensus supports flexible dosing approaches based on individual patient tolerance, with recognition that real-world practice often differs from clinical trial protocols. This personalized medicine approach acknowledges that one-size-fits-all dosing may not optimize outcomes for all patients with colorectal cancer.