Third-Line Treatment and Optimal Dosing in mCRC

This episode, “Third-Line Treatment and Optimal Dosing in mCRC,” features the panel discussing how the third-line treatment landscape has evolved and how dosing strategies may improve treatment tolerability and convenience. Dr. Fakih reviews the impact of the SUNLIGHT trial, which established trifluridine and tipiracil plus bevacizumab as an important third-line option for patients without an available biomarker-driven therapy. He discusses how adding bevacizumab improved disease control and progression-free survival compared with trifluridine and tipiracil alone, including in patients previously exposed to bevacizumab. The combination has become his preferred third-line approach.

The conversation also considers how trifluridine and tipiracil plus bevacizumab compares with regorafenib and fruquintinib. Expected tolerability, bone marrow function, prior therapy, and patient preferences may all influence treatment selection.

Dr. Parseghian then discusses an every-other-week dosing strategy for trifluridine and tipiracil, particularly when paired with biweekly bevacizumab. She reviews real-world data suggesting less myelosuppression, fewer treatment interruptions, and a simpler schedule for patients. Available evidence has shown reassuring efficacy, although prospective phase 3 evaluation is still pending. The episode highlights how third-line care is evolving through both new treatment combinations and efforts to optimize the administration of established therapies.

In the next episode, “Positioning Third-Line TKIs in mCRC,” the panel examines how fruquintinib and regorafenib may fit into individualized later-line treatment.