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Clinical Experience with Regorafenib in HCC

Insights From: Richard S. Finn, MD, Geffen School of Medicine;Arndt Vogel, MD, Hannover Medical School
Published: Wednesday, Dec 21, 2016


Transcript:

Arndt Vogel, MD:
In my clinical practice, I have used regorafenib, so far, mainly, or mostly, in patients with colorectal cancer because it’s not yet approved for patients with hepatocellular carcinoma. But, we participated in both trials, in the CORRECT trial for patients with colorectal cancer and also in the RESORCE study for patients with HCC. When we think about patients with colorectal cancer who are not used to multi-tyrosine kinase inhibitors, of course, we see quite a considerable number of side effects, and side-effect management is an important part of our treatments in this group of patients.

When we started with the RESORCE study, I wasn’t really sure whether this drug was a good drug for patients with HCC, liver cirrhosis, or poor liver function after sorafenib. I was a little bit skeptical about it. But, my experience in the RESORCE study was quite different. I think patients who are used to sorafenib tolerate regorafenib much better than patients who have never been treated before with multi-tyrosine kinase inhibitors.

In contrast to my experience in colorectal cancer, I think regorafenib is much better tolerated in patients with HCC who do tolerate sorafenib in first line. So, here, my experience was really better and I’m looking forward to using it now in the daily clinical practice. We will see whether we get similar results as I have seen it in the RESORCE study.

Richard Finn, MD: As we look at the side-effect profile of regorafenib, it obviously has some overlap with sorafenib. In the colon cancer space where it’s used, often these patients are relatively heavily pretreated with chemotherapy over the course of several months, if not years. And, I think, the tolerability in that population is different than in the RESORCE population. Unlike other studies in liver cancer, which would enroll patients who did not tolerate sorafenib, the RESORCE study had a requirement that patients had to be on sorafenib for a certain period of time at a certain dose.

And, by doing that, I think patients and doctors have a certain level of comfort with managing the toxicities we see with regorafenib. That’s different than in the colon cancer space where there are not necessarily overlapping side effects between regorafenib and the EGFR drugs, or bevacizumab, or even the cytotoxics that are used. Doctors should not necessarily expect to see the same level of intolerance that they see in the colon cancer population in the liver cancer population. They should have some comfort in how to manage these side effects in the context of patients being on sorafenib. Again, when indicated, doing dose reductions, using Imodium, and urea-based creams for hand-foot syndrome. Fatigue is often something difficult for us to manage because there’s not a medication that helps, per se, but we can advise patients on good sleeping habits, and, again, at times take a treatment break or even do a dose reduction. Keep in mind, in the liver cancer cohort, patients do take it for 3 weeks on and 1 week off. Take advantage of that week off to get rest.

Transcript Edited for Clarity
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Transcript:

Arndt Vogel, MD:
In my clinical practice, I have used regorafenib, so far, mainly, or mostly, in patients with colorectal cancer because it’s not yet approved for patients with hepatocellular carcinoma. But, we participated in both trials, in the CORRECT trial for patients with colorectal cancer and also in the RESORCE study for patients with HCC. When we think about patients with colorectal cancer who are not used to multi-tyrosine kinase inhibitors, of course, we see quite a considerable number of side effects, and side-effect management is an important part of our treatments in this group of patients.

When we started with the RESORCE study, I wasn’t really sure whether this drug was a good drug for patients with HCC, liver cirrhosis, or poor liver function after sorafenib. I was a little bit skeptical about it. But, my experience in the RESORCE study was quite different. I think patients who are used to sorafenib tolerate regorafenib much better than patients who have never been treated before with multi-tyrosine kinase inhibitors.

In contrast to my experience in colorectal cancer, I think regorafenib is much better tolerated in patients with HCC who do tolerate sorafenib in first line. So, here, my experience was really better and I’m looking forward to using it now in the daily clinical practice. We will see whether we get similar results as I have seen it in the RESORCE study.

Richard Finn, MD: As we look at the side-effect profile of regorafenib, it obviously has some overlap with sorafenib. In the colon cancer space where it’s used, often these patients are relatively heavily pretreated with chemotherapy over the course of several months, if not years. And, I think, the tolerability in that population is different than in the RESORCE population. Unlike other studies in liver cancer, which would enroll patients who did not tolerate sorafenib, the RESORCE study had a requirement that patients had to be on sorafenib for a certain period of time at a certain dose.

And, by doing that, I think patients and doctors have a certain level of comfort with managing the toxicities we see with regorafenib. That’s different than in the colon cancer space where there are not necessarily overlapping side effects between regorafenib and the EGFR drugs, or bevacizumab, or even the cytotoxics that are used. Doctors should not necessarily expect to see the same level of intolerance that they see in the colon cancer population in the liver cancer population. They should have some comfort in how to manage these side effects in the context of patients being on sorafenib. Again, when indicated, doing dose reductions, using Imodium, and urea-based creams for hand-foot syndrome. Fatigue is often something difficult for us to manage because there’s not a medication that helps, per se, but we can advise patients on good sleeping habits, and, again, at times take a treatment break or even do a dose reduction. Keep in mind, in the liver cancer cohort, patients do take it for 3 weeks on and 1 week off. Take advantage of that week off to get rest.

Transcript Edited for Clarity
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