Real world aspects of palliative trifluridine plus tiperacil (TAS-102) in refractory metastatic colorectal cancer

Mikael Wallander; Bo Rolander; Elisabeth Åvall-Lundqvist; Nils O Elander

doi:10.21037/jgo-20-43

Real world aspects of palliative trifluridine plus tiperacil (TAS-102) in refractory metastatic colorectal cancer

J Gastrointest Oncol. 2020 Aug;11(4):616-625. doi: 10.21037/jgo-20-43.

Authors

Mikael Wallander¹, Bo Rolander^{2

3}, Elisabeth Åvall-Lundqvist^{4

5}, Nils O Elander^{4

5}

Affiliations

¹ Department of Oncology, Ryhov County Hospital, SE-55305 Jönköping, Sweden.
² Futurum - Academy for Healthcare, Region Jönköping County, Sweden.
³ Department of Behavioural Science and Social Work, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
⁴ Department of Oncology, Linköping University, SE-58185 Linköping, Sweden.
⁵ Department of Biomedical and Clinical Sciences, Linköping University, SE-58185 Linköping, Sweden.

Abstract

Background: While recent randomised phase III trials show that trifluridine/tiperacil (TAS-102) may prolong life in patients with refractory metastatic colorectal cancer (rmCRC), palliative aspects on its efficacy and tolerability in real world patients need further elucidation.

Methods: A retrospective observational multicentre study was designed, including all patients with rmCRC who received TAS-102 under 2016-2019 in the South East Health Care region of Sweden. 48 patients were identified. Primary outcome was overall survival (OS) and secondary outcomes were progression-free survival (PFS), time to ECOG performance status deterioration (PSD), safety and dose reductions, admission to and duration of access to palliative care, and administration of TAS-102 in the last 30 days before death.

Results: Median OS, PFS, and time to PSD (a proxy for impaired quality of life) from start of TAS-102 were 6.4 months (95% CI: 4.4-8.4), 2.3 months (95% CI: 1.8-2.7) and 2.5 months (95% CI: 1.9-3.2), respectively. Following uni- and multivariable regression analyses, the number of previous treatment lines (≤2 vs. ≥3) was statistically independent for OS (median 7.8 vs. 5.3 months, P=0.05), PFS (median 2.4 vs. 1.8 months, P=0.03), and time to PSD (median 2.8 vs. 1.8 months, P=0.03). Thirty-four (71%) of the patients received reduced doses. The most common grade 3-4 toxicity was neutropenia (39%). Forty-three (90%) were admitted to GP or hospital-based home palliative care. Median time for access to any form of palliative care before death was 2.3 (95% CI: 0.5-3.2) months. Few patients (n=3, 7%) received their last dose of TAS-102 in their last 30 days of life.

Conclusions: The outcome and tolerability of TAS-102 in rmCRC appear similar in a real-world context and randomised trials. The retrospective design and limited sample size preclude firm conclusions on subgroup analyses, but it appears that the prognosis is slightly better the earlier TAS-102 is introduced. Treatment durations are generally short, and early admission to a palliative care provider is recommended.

Keywords: Trifluridine and tiperacil (TAS-102); chemotherapy; colorectal neoplasms; palliative care.