Third-line treatment decision-making for mCRC: a cross-sectional survey of US community physicians

Abstract Background Colorectal cancer (CRC) is the second leading cause of cancer-related death worldwide, with increasing incidence in US. Improvements in disease management and the increasing incidence of patients with metastatic CRC (mCRC) at younger ages means that more patients survive to continue to the third-line treatment setting. Treatment has evolved beyond chemotherapy with the approval of newer agents, but there is no consensus on the optimized choice or sequencing in this treatment setting. Identification of the drivers of treatment decisions may provide evidence to guide decision making, ensuring that patients receive optimal care. The objective of this study was to evaluate treatment preferences and prescribing patterns for third-line mCRC among community-based physicians. Methods This study surveyed community-based physicians in the US who were actively treating patients with mCRC. Results Overall survival (OS) and impacts to patient quality of life (QoL) were primary considerations for any third-line treatment for mCRC. Physicians considered OS and progression-free survival (PFS) as extremely important factors when making third-line treatment decisions. Most physicians selected trifluridine-tipiracil (FTD-TPI) combined with bevacizumab as their first treatment choice for third-line mCRC (60%), compared to regorafenib (12%), FTD-TPI monotherapy (8%), capecitabine (8%), and fruquintinib (6%). Physicians identified fatigue, neutropenia, and hand foot syndrome as the most challenging adverse events (AEs) to manage, while hand foot syndrome and allergic reactions were the AEs that would most likely lead physicians to discontinue treatment. Conclusion These findings highlight the third-line treatment preferences and prescribing patterns of community-based physicians who are actively treating patients with mCRC.