Clinic for Medical Oncology and Hematology, Universitätsspital Zürich and University of Zurich, Zurich, Switzerland,
Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland.
Oncol Res Treat. 2020;43(5):237-244. doi: 10.1159/000506080. Epub 2020 Mar 6.
Metastatic colorectal carcinoma (mCRC) is one of the most prevalent types of cancer worldwide. After tumor progression with first- and second-line treatment, trifluridine (FTD) and tipiracil (TPI) has been shown to be a treatment option.
Data from a pivotal phase 3 trial (RECOURSE) and an ongoing phase 3b trial (PRECONNECT) have shown that, in mCRC patients who experienced disease progression after 2 lines of standard therapy, treatment with FTD/TPI is safe and efficacious. Other third-line options include regorafenib, rechallenge with previous treatment lines or personalized approaches based on comprehensive molecular profiling. Randomized trials or sequential studies aiming for the right treatment sequence or predefined subtypes for FTD/TPI or regorafenib as well for rechallenge are missing. However, FTD/TPI as well as regorafenib are recommended by the current ESMO, German S3, and National Comprehensive Cancer Network (NCCN) guidelines in the same situation, thus offering physicians a number of alternatives for the treatment of mCRC patients after the second progression. Key Message: This narrative review summarizes published data and their impact for FTD/TPI as well for regorafenib and rechallenge chemotherapy in clinical practice settings of refractory situations of colorectal cancer.
转移性结直肠癌（mCRC）是全球最常见的癌症类型之一。在一线和二线治疗后肿瘤进展后，三氟尿苷（FTD）和替匹嘧啶（TPI）已被证明是一种治疗选择。
来自关键的 3 期试验（RECOURSE）和正在进行的 3b 期试验（PRECONNECT）的数据表明，在接受 2 线标准治疗后疾病进展的 mCRC 患者中，FTD/TPI 治疗是安全有效的。其他三线治疗选择包括regorafenib、重新挑战以前的治疗线或基于全面分子谱分析的个体化方法。缺少旨在确定 FTD/TPI 或regorafenib 以及重新挑战的正确治疗顺序或预定义亚型的随机试验或序贯研究。然而，FTD/TPI 和 regorafenib 都被当前的 ESMO、德国 S3 和国家综合癌症网络（NCCN）指南推荐在相同的情况下使用，因此为医生在二线进展后治疗 mCRC 患者提供了许多替代方案。关键信息：本综述总结了发表的数据及其对 FTD/TPI、regorafenib 和重新挑战化疗在结直肠癌难治性情况下的临床实践中的影响。
