Personalized Approaches to Treatment of Metastatic Colorectal Cancer - Episode 12

Best Strategies for Sequencing Regorafenib in mCRC

April 30, 2021
Tanios Bekaii-Saab, MD, Mayo Clinic

,
Cathy Eng, MD, FACP, FASCO, Vanderbilt-Ingram Cancer Center

,
Joleen Hubbard, MD, Mayo Clinic

,
Kanwal Raghav, MD, MBBS, The University of Texas MD Anderson Cancer Center

,
John H. Strickler, MD, Duke Cancer Institute

Considerations for how to sequence therapy with regorafenib for relapsed or refractory metastatic colorectal cancer based on the REVERCE II study.

Tanios S. Bekaii-Saab, MD: Going back to this concept of sequencing, there were interesting data from our friends in Japan that suggested if you went with regorafenib first followed by an EGFR inhibitor, the survival outcome is more favorable vs doing the reverse. That data looked very impressive, although the study was cut short. Any thoughts? Do we need to duplicate these results in the United States? Does it matter?

John H. Strickler, MD: These were very intriguing data that came out of Japan, where they asked a question: What sequence is better for a patient who is KRAS wild type? At the time the study was run, they were testing KRAS. They randomized patients to receive the anti-EGFR therapy first followed by regorafenib or regorafenib first followed by the anti-EGFR therapy. They did see a survival advantage for those patients who received regorafenib before the anti-EGFR. That study was cut short, and we think it does need some additional validation in the United States, so that led to the REVERCE II trial. We are asking the same question in a US population because it could be very constructive if that’s positive here as well.

Transcript Edited for Clarity