Anlotinib combined with TAS-102 as the third-line treatment for a patient with metastatic colon cancer: A case report

Abstract

Chemotherapy combined with targeted therapy is a first-line and second-line treatment for metastatic colorectal cancer(mCRC), which has brought survival benefits to mCRC patients, however, disease progression is inevitable. More than 60% of patients still needed third-line treatment after the progress of second-line treatment. After the failure of second-line chemotherapy, treatment compliance and the physical tolerance of patients both decrease. Therefore, choosing an appropriate third-line treatment regimen is key to prolonging survival and improving quality of life. As a novel cytotoxic antitumor drug, trifluridine/tipiracil (TAS-102) is composed of trifluridine (FTD) and tipiracil hydrochloride (TPI). FTD can directly bind to the DNA of cancer cells to cause DNA dysfunction, thereby exerting antitumor effects. TPI can inhibit the degradation of FTD, thereby increasing its cytotoxicity. The few side effects of TAS-102 has become an important reason why clinicians present it as a treatment option to the patient for consideration, clinical trial data for progression free survival are lacking. The exploration of third-line treatment regimens with drug combinations has attracted much attention. This article reports a case of metastatic colon cancer (RAS/BRAF wild type, pMMR/Non-MSI-H), after failure of first-line and second-line therapies, the patient was eventually treated with anlotinib combined with TAS-102 as the third-line treatment. The treatment has shown good efficacy, with a long PFS benefit for more than 20 months and mild adverse reactions. This case reports demonstrates that anlotinib combined with TAS-102 is a promising third-line treatment regimen for refractory mCRC, and provides proof-of-concept for the clinical exploration of optimal third-line combination treatment regimens.

Trifluridine/tipiracil (FTD/TPI) in metastatic colorectal cancer treatment

“…The confirmed activity of FTD/TPI in monotherapy and positive preclinical studies with FTD/TPI in polytherapy support findings of the clinical trials that assess the combination of FTD/TPI with targeted therapy like bevacizumab (anti-VEGF monoclonal antibody), nivolumab (anti-PD-1) or trametinib [19][20][21][22][23][24][25][26][27][28][29].…”

“…[28] In China, a patient treated with FTD/TPI and anlotinib (multitarget tyrosine kinase inhibitor) in the third line of treatment (RAS/BRAF wild-type, pMMR/non-MSI-H) achieved PFS of 20 mo. [29].…”