Efficacy and safety of regorafenib in the treatment of metastatic colorectal cancer: A systematic review

• Published in: Cancer treatment reviews 2018-01, Vol.62, p.61-73
• Main Authors: Røed Skårderud, Maria, Polk, Anne, Kjeldgaard Vistisen, Kirsten, Larsen, Finn Ole, Nielsen, Dorte Lisbet
• Format: Article
• Language: English
• Subjects: Colorectal cancer; Metastatic colorectal cancer; Protein-kinase inhibitors; Regorafenib; Systematic review
• ISSN: 0305-7372; 1532-1967
• DOI: 10.1016/j.ctrv.2017.10.011

•Late line single agent treatment with regorafenib improves PFS and OS.•Survival benefits of 1.4 and 2.5 months were seen in phase III RCTs.•Adverse events were common, but manageable.•Hand-foot-skin reaction was one of the most frequently reported adverse events.•Dose modifications and discontinuations were frequent during regorafenib treatment. Despite advances in the treatment of colorectal cancer, third-line treatment options are still limited. Regorafenib was approved in 2012 for the treatment of patients with metastatic colorectal cancer previously treated with approved standard therapy. The purpose of this review is to present existing clinical data on regorafenib. We systematically searched the PubMed and Embase databases, as well as ASCO and ESMO conference abstracts, for studies in English including ≥30 patients, evaluating the efficacy and safety of regorafenib in patients with metastatic colorectal cancer. A meta-analysis was conducted on the published, randomized phase III trials. 24 eligible studies were included. In two phase III trials, regorafenib significantly increased overall survival (OS), progression free survival (PFS), and disease control rate when compared to placebo. Survival benefits of 1.4 and 2.5 months were presented. The meta-analysis indicated a significant greater treatment effect on OS (hazard ratio 0.67) and PFS (hazard ratio 0.40), compared to placebo. The non-randomized studies mostly supported these results. The most frequently reported adverse events were hand-foot-skin reaction (25%–86%), hypertension (11%–47%) and fatigue (2%–73%). Large phase III randomized trials indicate that regorafenib provides a benefit in OS and PFS when compared to placebo. Adverse events were common, but manageable and typical of multi-target tyrosine kinase inhibitors. Further research is needed to investigate alternative approaches to the dosing of regorafenib and to explore clinical and molecular biomarkers that can guide patient selection.