Dr Strickler on the Significance of Fruquintinib for Patients With Refractory mCRC

John H. Strickler, MD, associate professor, medicine, Department of Medical Oncology, Duke Cancer Center, discusses how the FDA approval of fruquintinib (Fruzaqla) has expanded the later-line treatment arsenal for patients with metastatic colorectal cancer (mCRC), as well as potential next steps for evaluating this agent in combination regimens within this disease.

On November 8, 2023, fruquintinib received FDA approval for the treatment of adult patients with mCRC who were previously treated with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy; a VEGF inhibitor; and an EGFR inhibitor if deemed medically appropriate for those with RAS wild-type disease. This approval was primarily supported by data from the phase 3 FRESCO-2 (NCT04322539) and Chinese FRESCO (NCT02314819) trials.

The approval of fruquintinib marks a significant advancement for patients with mCRC who have exhausted multiple lines of standard therapies, Strickler begins. Historically, treatment options for patients who progress on multiple lines of chemotherapy have been limited, with current approved agents often offering low response rates and only modest improvements in progression-free survival (PFS) and overall survival (OS), he details. Fruquintinib, a potent VEGF TKI, has demonstrated the ability to improve both PFS and OS and is generally well tolerated by patients, Strickler says.

One of the unique aspects of fruquintinib is that it is an effective treatment that does not involve cytotoxic chemotherapy, Strickler states, adding that this distinguishes it from other therapies and provides a novel approach for managing mCRC. Fruquintinib has shown significant benefit not only in patients who are refractory to all standard therapies, typically in the fourth line or later, but also appears to be effective when used in later lines of therapy. This includes patients who have progressed on only 2 prior lines of treatment with regimens including 5-fluorouracil, oxaliplatin, irinotecan, or bevacizumab (Avastin).

The introduction of fruquintinib into clinical practice provides oncologists with another valuable option in their treatment arsenal, but determining how best to integrate fruquintinib into treatment protocols will depend on individual patient circumstances, Strickler summarizes. Its use may be considered immediately following progression on chemotherapy regimens like FOLFOX or FOLFIRI, or it may be reserved for patients who have undergone multiple lines of therapy and are truly refractory, he concludes.