Objectives
After induction treatment, maintenance therapy with chemotherapy, targeted therapy, or a combination of both is widely used in mCRC patients. Hospital admission for maintenance treatment like bevacizumab may increase COVID-19 exposure risk during the epidemic. Exploring oral drugs as maintenance treatment could reduce hospitalization and exposure risk. Fruquintinib, an oral VEGFR inhibitor, exhibits promising safety and efficacy in mCRC treatment. However, evidence supporting fruquintinib as a maintenance therapy is still limited.This retrospective analysis is aimed to evaluate the efficacy and tolerability of fruquintinib.
Sample and setting
This retrospective study analyzed 25 patients with unresectable mCRC who received ≥ 6 cycles of first-line induction therapy and subsequently received fruquintinib as maintenance therapy (5 or 4 mg, QD, d1-21, Q4W) between July 2019 and December 2023.
Procedures
The primary and secondary endpoint were median progression-free survival (mPFS, defined as starting of fruquintinib treatment to the first occurrence of disease progression or death) and PFS1(defined as the time from the initiation of first-line induction chemotherapy to the first occurrence of disease progression or death). The Boruta algorithm was employed to identify variables affecting PFS and PFS1. Landmark analysis evaluated the impact of lymph node metastasis(LNM) on progression risk before and after induction.
Results
Median follow-up was 13.1 months and mPFS was 12.4 months (95%CI 6.4-32.5). Subgroup analysis showed longer mPFS in patients with LNM (n=18) versus those without (n=7) (32.5 vs. 7.4 months, P=0.03). Restricted cubic spline analysis revealed a significant non-linear relationship between the duration of fruquintinib maintenance therapy and progression risk. In landmark analysis, patients with LNM exhibited a significantly lower risk of progression compared to those without.
Conclusion and clinical implications
Fruquintinib demonstrated encouraging clinical activity and an acceptable safety profile as a first-line maintenance therapy for patients with mCRC.