Abstract
Regorafenib is an orally available multikinase inhibitor, currently approved in metastatic chemorefractory colorectal cancer patients. The results of two large randomized Phase III trials are available, providing significant results in overall and progression-free survival in this situation. Its use requires a special attention regarding patient selection, dosing schedule and management of adverse events. Identifying patients who will tolerate and have benefit from regorafenib is a challenge for clinicians. Therapeutic monitoring (especially cfDNA), predictive biomarkers and specific perfusion-based imaging techniques will may be result in optimizing regorafenib treatment.
Papers of special note have been highlighted as: • of interest; •• of considerable interest
References
- 1 Stivarga. Full prescribing information. www.stivarga-us.com/full-pi/.Google Scholar
- 2 Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int. J. Cancer 136(5), e359–e386 (2015). • Provides an estimation of the worldwide incidence and mortality from 27 major cancers including metastatic colorectal cancer (mCRC).Crossref, Medline, CAS, Google Scholar
- 3 ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann. Oncol. 27(8), 1386–1422 (2016). • Describes the current optimal management of mCRC.Crossref, Medline, CAS, Google Scholar
- 4 . Recent developments in the discovery of protein kinase inhibitors from the urea class. Curr. Opin. Drug Discov. Devel. 7(5), 600–616 (2004).Medline, CAS, Google Scholar
- 5 Regorafenib (BAY 73–4506): a new oral multikinase inhibitor of angiogenic, stromal and oncogenic receptor tyrosine kinases with potent preclinical antitumor activity. Int. J. Cancer 129(1), 245–255 (2011).Crossref, Medline, CAS, Google Scholar
- 6 A Phase I dose-escalation study of regorafenib (BAY 73–4506), an inhibitor of oncogenic, angiogenic, and stromal kinases, in patients with advanced solid tumors. Clin. Cancer Res. 18, 2658–2667 (2012).Crossref, Medline, CAS, Google Scholar
- 7 Regorafenib (BAY 73–4506) in advanced colorectal cancer: a Phase I study. Br. J. Cancer 106, 1722–1727 (2012).Crossref, Medline, CAS, Google Scholar
- 8 Pharmacologic activity and pharmacokinetics of metabolites of regorafenib in preclinical models. Cancer Med. 5(11), 3176–3185 (2016).Crossref, Medline, CAS, Google Scholar
- 9 Effect of glucuronidation on transport and tissue accumulation of tyrosine kinase inhibitors: consequences for the clinical management of sorafenib and regorafenib. Expert Opin. Drug Metab. Toxicol. 11(5), 785–794 (2015).Crossref, Medline, CAS, Google Scholar
- 10 Regorafenib monotherapy for previously treated metastatic colorectal cancer (CORRECT): an international, multicentre, randomised, placebo-controlled, Phase III trial. Lancet 381, 303–312 (2013). •• First Phase III study evaluating regorafenib in mCRC.Crossref, Medline, CAS, Google Scholar
- 11 Regorafenib plus best supportive care versus placebo plus best supportive care in Asian patients with previously treated metastatic colorectal cancer (CONCUR): a randomised, double-blind, placebo-controlled, Phase III trial. Lancet Oncol. 16, 619–629 (2015). •• Second Phase III randomized study evaluating regorafenib in mCRC in an Asian population.Crossref, Medline, CAS, Google Scholar
- 12 Survival, safety, and prognostic factors for outcome with regorafenib in patients with metastatic colorectal cancer refractory to standard therapies: results from a multicenter study (REBECCA) nested within a compassionate use program. BMC Cancer 16, 412 (2016). • Describes the French cohort study called REBECCA that evaluated the efficacy and safety of regorafenib in the real life setting for 654 patients.Crossref, Medline, Google Scholar
- 13 LBA-05 results from the large, open-label Phase IIIb CONSIGN study of regorafenib in patients with previously treated metastatic colorectal cancer. Ann. Oncol. 26(Suppl. 4), iv118–iv118 (2015). • Describes another cohort study with regorafenib in mCRC including 2872 patients.Crossref, Google Scholar
- 14 . A systematic review and meta-analysis of retrospective series of regorafenib for treatment of metastatic colorectal cancer. Anticancer Res. 37(11), 5925–5934 (2017). • First meta-analysis reviewing the main results of regorafenib in CRC.Medline, CAS, Google Scholar
- 15 Investigation of regorafenib-induced hypothyroidism in patients with metastatic colorectal cancer. Anticancer Res. 35(7), 4059–4062 (2015).Medline, CAS, Google Scholar
- 16 Regorafenib-induced hypothyroidism and cancer-related fatigue: is there a potential link? Eur. J. Endocrinol. 177(1), 85–92 (2017).Crossref, Medline, CAS, Google Scholar
- 17 Randomized Phase III trial of regorafenib in metastatic colorectal cancer: analysis of the CORRECT Japanese and non-Japanese subpopulations. Invest. New Drugs 33(3), 740–750 (2015).Crossref, Medline, CAS, Google Scholar
- 18 . Recent developments in the treatment of metastatic colorectal cancer. Ther. Adv. Med. Oncol. 9(8), 551–564 (2017).Crossref, Medline, CAS, Google Scholar
- 19 . A comparison of regorafenib and TAS-102 for metastatic colorectal cancer: a systematic review and network meta-analysis. Clin. Colorectal Cancer
doi:10.1016/j.clcc.2017.10.016 (2017). • Retrospective and indirect comparison of regorafenib and trifluridine/tipiracil (TAS-102) in mCRC.Crossref, Medline, Google Scholar - 20 Prevention and management of adverse events related to regorafenib. Support. Care Cancer 22(3), 837–846 (2014).Crossref, Medline, Google Scholar
- 21 . Optimizing treatment outcomes with regorafenib: personalized dosing and other strategies to support patient care. Oncologist 19(6), 669–680 (2014).Crossref, Medline, CAS, Google Scholar
- 22 . Proactive strategies for regorafenib in metastatic colorectal cancer: implications for optimal patient management. Cancer Manag. Res. 6, 93–103 (2014).Crossref, Medline, Google Scholar
- 23 Prognostic clinical factors in pretreated colorectal cancer patients receiving regorafenib: implications for clinical management. Oncotarget 6(32), 33982–33992 (2015).Crossref, Medline, Google Scholar
- 24 Estimating 12-week death probability in patients with refractory metastatic colorectal cancer: the colon life nomogram. Ann. Oncol. 28(3), 555–561 (2017).Crossref, Medline, CAS, Google Scholar
- 25 . Molecular profiling in the treatment of colorectal cancer: focus on regorafenib. Onco Targets Ther. 8, 2949–2957 (2015).Medline, CAS, Google Scholar
- 26 Serum VEGF-A and CCL5 levels as candidate biomarkers for efficacy and toxicity of regorafenib in patients with metastatic colorectal cancer. Oncotarget 7(23), 34811–34823 (2016).Crossref, Medline, Google Scholar
- 27 KDR mutation as a novel predictive biomarker of exceptional response to regorafenib in metastatic colorectal cancer. Cureus 8(2), e478 (2016).Medline, Google Scholar
- 28 The sum of gains and losses of genes encoding the protein tyrosine kinase targets predicts response to multi-kinase inhibitor treatment: characterization, validation, and prognostic value. Oncotarget 6(28), 26388–26399 (2015).Crossref, Medline, Google Scholar
- 29 Analysis of circulating DNA and protein biomarkers to predict the clinical activity of regorafenib and assess prognosis in patients with metastatic colorectal cancer: a retrospective, exploratory analysis of the CORRECT trial. Lancet Oncol. 16(8), 937–948 (2015).Crossref, Medline, CAS, Google Scholar
- 30 Clinical outcome and molecular characterisation of chemorefractory metastatic colorectal cancer patients with long-term efficacy of regorafenib treatment. ESMO Open 2(3), e000177 (2017).Crossref, Medline, Google Scholar
- 31 Off-target effects and clinical outcome in metastatic colorectal cancer patients receiving regorafenib: the TRIBUTE analysis. Sci. Rep. 7, 45703 (2017).Crossref, Medline, CAS, Google Scholar
- 32 Radiological imaging markers predicting clinical outcome in patients with metastatic colorectal carcinoma treated with regorafenib: post hoc analysis of the CORRECT Phase III trial (RadioCORRECT study). ESMO Open 1(6), e000111 (2017).Crossref, Medline, Google Scholar
- 33 Functional imaging and circulating biomarkers of response to regorafenib in treatment-refractory metastatic colorectal cancer patients in a prospective Phase II study. Gut
doi:10.1136/gutjnl-2017-314178 (2017).Crossref, Google Scholar - 34 Prophylactic use of oral dexamethasone to alleviate fatigue during regorafenib treatment for patients with metastatic colorectal cancer. Clin. Colorectal Cancer 16(2), e39–e44 (2017).Crossref, Medline, Google Scholar
- 35 . Regorafenib in metastatic colorectal cancer: optimal dosing and patient selection recommendations. Clin. Adv. Hematol. Oncol. 13, 514–517 (2015). • Describes a dose-escalation protocol for regorafenib to reduce toxicities in the first cycle of treatment.Medline, Google Scholar
- 36 . Regorafenib: start low and go slow. Target Oncol. 10, 445–447 (2015).Crossref, Medline, CAS, Google Scholar
- 37 [Investigation of Administration Technique of Regorafenib in Our Center]. Gan To Kagaku Ryoho 44(1), 47–51 (2017).Medline, CAS, Google Scholar
- 38 . Comment on: “regorafenib: start low and go slow”. Target Oncol. 11(1), 123–125 (2016).Crossref, Medline, Google Scholar
- 39 Simultaneous analysis of regorafenib and sorafenib and three of their metabolites in human plasma using LC–MS/MS. J. Pharm. Biomed. Anal. 142, 42–48 (2017).Crossref, Medline, CAS, Google Scholar
- 40 . Oral versus intravenous fluoropyrimidines for colorectal cancer. Cochrane Database Syst. Rev. 7, CD008398 (2017).Medline, Google Scholar
- 41 Adherence and safety of regorafenib for patients with metastatic colorectal cancer: observational real-life study. Future Oncol. 13(5), 415–423 (2017).Link, CAS, Google Scholar
- 42 FDA approves regorafenib (Stivarga) for metastatic colorectal cancer. Oncology (Williston Park) 26(10), 896 (2012).Google Scholar
- 43 Regorafenib in combination with FOLFOX or FOLFIRI as first- or second-line treatment of colorectal cancer: results of a multicenter, Phase Ib study. Ann. Oncol. 24(6), 1560–1567 (2013).Crossref, Medline, CAS, Google Scholar
- 44 Regorafenib plus modified FOLFOX6 as first-line treatment of metastatic colorectal cancer: a Phase II trial. Eur. J. Cancer 51(8), 942–949 (2015).Crossref, Medline, CAS, Google Scholar
- 45 Adjuvant regorafenib (reg) in stage IV colorectal cancer (CRC) after curative treatment of liver metastases: a Phase III randomized, placebo (pbo)-controlled trial (COAST). Ann. Oncol. 25(Suppl. 4), iv208–iv208 (2014).Crossref, Google Scholar

