Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, INSERM 938, SIRIC CURAMUS, Sorbonne University, 184 Rue du Faubourg Saint Antoine, 75012, Paris, France.
Digestive Oncology, University Hospitals Gasthuisberg Leuven, KU Leuven, Leuven, Belgium.
Curr Treat Options Oncol. 2024 Oct;25(10):1312-1322. doi: 10.1007/s11864-024-01261-w. Epub 2024 Sep 26.
Recommended first and second line treatments for unresectable metastatic colorectal cancer (mCRC) include fluorouracil-based chemotherapy, anti-vascular endothelial growth factor (VEGF)-based therapy, and anti-epidermal growth factor receptor-targeted therapies. In third line, the SUNLIGHT trial showed that trifluridine/tipiracil + bevacizumab (FTD/TPI + BEV) provided significant survival benefits and as such is now a recommended third line regimen in patients with refractory mCRC, irrespective of RAS mutational status and previous anti-VEGF treatment. Some patients are not candidates for intensive combination chemotherapy as first-line therapy due to age, low tumor burden, performance status and/or comorbidities. Capecitabine (CAP) + BEV is recommended in these patients. In the SOLSTICE trial, FTD/TPI + BEV as a first line regimen in patients not eligible for intensive therapy was not superior to CAP + BEV in terms of progression-free survival (PFS). However, in SOLSTICE, FTD/TPI + BEV resulted in similar PFS, overall survival, and maintenance of quality of life as CAP + BEV, with a different safety profile. FTD/TPI + BEV offers a possible first line alternative in patients for whom CAP + BEV is an unsuitable treatment. This narrative review explores and summarizes the clinical trial data on FTD/TPI + BEV.
不可切除的转移性结直肠癌（mCRC）的一线和二线治疗推荐包括基于氟尿嘧啶的化疗、抗血管内皮生长因子（VEGF）治疗和抗表皮生长因子受体靶向治疗。在三线治疗中，SUNLIGHT 试验表明，三氟嘧啶/替匹嘧啶+贝伐珠单抗（FTD/TPI+BEV）提供了显著的生存获益，因此现在是难治性 mCRC 患者的三线治疗方案，无论 RAS 突变状态和先前的抗 VEGF 治疗如何。由于年龄、肿瘤负荷低、表现状态和/或合并症，一些患者不适合一线强化联合化疗。卡培他滨（CAP）+贝伐珠单抗在这些患者中被推荐使用。在 SOLSTICE 试验中，对于不适合强化治疗的患者，FTD/TPI+BEV 作为一线治疗方案在无进展生存期（PFS）方面并不优于 CAP+BEV。然而，在 SOLSTICE 试验中，FTD/TPI+BEV 与 CAP+BEV 相比，在 PFS、总生存期和生活质量维持方面具有相似的疗效，且安全性谱不同。FTD/TPI+BEV 为 CAP+BEV 不适用的患者提供了一种可能的一线替代方案。本文对 FTD/TPI+BEV 的临床试验数据进行了探讨和总结。
