(303) Real-world (RW) sequential regorafenib and trifluridine/tipiracil + bevacizumab (BEV) treatment for metastatic colorectal cancer (mCRC) in the United States (US) community oncology setting A post-hoc analysis of SEQRT2 study

Background: : Regorafenib (R) and Trifluridine/Tipiracil (T) ± BEV are widely used treatments for mCRC after patients advance on standard of care.

Objective: : This subgroup analysis of a RW study evaluated optimal sequencing and associated outcomes among patients who initiated R and T in sequential lines of therapy (LOT) between LOT 3-6 within community oncology settings in the US.

Methods: : A retrospective study utilizing electronic medical record data from The US Oncology Network examined adult patients with mCRC who initiated R and T ± BEV sequentially between third to sixth LOT between 09/01/2015 and 11/30/2022 (index date), with follow-up until 05/31/2023. Treatment patterns and overall survival (OS) were assessed R first (R-T) and T first (T-R).

Results: : In total, 238 mCRC patients-initiated R and T (R-T, 119pts [107 R-T and 12 R-T+BEV]; T-R, 119 pts [108 T-R and 11 T+BEV-R]) as 3rd-6th line therapy. Baseline demographic consisted of mean age 63.5 yrs, 55.9% < 65 years old, and males 55%. Clinical characteristics included 70% colon cancer, ECOG 0-1 (63.1% R-T and 59.7% T-R) and ECOG 2 (7.6% R-T and 5.9% T-R). Death (74.8%) was comparable among the groups. The median IQR sequence durations were 7.0 (5.1, 10) and 6.4 (4.7, 8.7) months, for R-T and T-R. Median (95% CI) OS was 12.2 (10.6,14) months among R-T and 9.8 (8.6,12.8) months among T-R patients. Survival probability at 12 months was 51.6% (41.8, 60.6) for R-T and 41.9% (32.4, 51.2) for T-R.

Conclusions: : Patients initiating R first in third to sixth LOT appeared to have a longer duration of treatment and survival, although not statistically significant. The one-year median duration of survival in this real-world setting for R-T sequence confirms the importance of access to these treatments in patients with mCRC and can inform physicians regarding the choice of medications while sequencing therapies in mCRC.

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