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

BACKGROUND: Colorectal cancer (CRC) is the second leading cause of cancer-related death worldwide, with increasing incidence in the US. Improvements in disease management and the increasing incidence of patients with metastatic CRC (mCRC) at younger ages has resulted in more patients being treated in the third-line setting. Treatment has evolved beyond chemotherapy with the approval of newer agents, but there is no consensus on the optimized choice or sequencing post second-line treatment. 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 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.