Real-world use of trifluridine/tipiracil for patients with metastatic colorectal cancer in Canada

Background

Outcomes for patients with metastatic colorectal cancer (mcrc) are improving with the introduction of new treatments. Treatment for patients who are still fit after failure of all available therapies represents a significant unmet need. In the present study, we analyzed real-world treatment patterns for patients enrolled in Health Canada's trifluridine/tipiracil (ftd/tpi) Special Access Program (sap) and Taiho Pharma Canada's Patient Support Program (psp).

Methods

Demographic information and clinical treatment data were collected from adults with mcrc who were previously treated with, or were not candidates for, available therapies and who were enrolled in the sap and psp. For all patients, ftd/tpi treatment status, discontinuation reasons, and prior therapies were examined.

Results

The analysis included 717 Canadian patients enrolled in the ftd/tpi sap and psp from September 2017 to October 2018. In that cohort, 59.7% were men, median age was 65 years, and median duration of therapy was 77 days (25%-75% interquartile range: 43-106 days). Of treated patients, 67.1% maintained the same dose for the duration of therapy; 28.0% had a dose reduction.On multivariable analysis, duration of therapy was not influenced by sex, age, province, RAS mutation status, or prior therapies. However, prior oxaliplatin-based chemotherapy (capox or folfox) appeared to be associated with higher rates of discontinuation because of death or disease progression.

Conclusions

In advanced mcrc, ftd/tpi is a well-tolerated therapy. The large number of patients enrolled in the access programs within a short period of time is reflective of major clinical need in this area, with many patients being eligible and interested in pursuing treatment in the refractory setting.

Going further in the knowledge of Yondelis®; what's new in daily clinical practice?

The approval of trabectedin in Europe in 2007 for the treatment of advanced soft tissue sarcoma (STS) was based on four Phase II trials. The extensive clinical trials program currently underway with trabectedin indicates clearly the extent to which this novel agent remains a topic of scientific and clinical interest in the treatment of advanced STS. Results of several retrospective studies examining outcomes of patients treated beyond clinical trials and under everyday practice conditions, including compassionate use programs, were disclosed in 2013. These analyses complement the knowledge about trabectedin gained from previous and ongoing clinical studies. Collectively, the results confirm the activity of trabectedin in inoperable/metastatic STS and extend current knowledge about several aspects of its profile, highlighting in particular improved outcomes when trabectedin is used in earlier lines of therapy and when treatment is maintained in the absence of disease progression. Evidence that the safety profile of trabectedin does not differ materially between elderly (≥65 years) and younger patients suggests no need to discriminate on the basis of age; elderly patients who are sufficiently fit to receive chemotherapy and considered by their physicians as unsuited to receive doxorubicin/ifosfamide can be treated with trabectedin in the same manner as younger patients.