(Colorectal Cancer) Efficacy of Trifluridine/Tipiracil (Lonsurf) Plus Bevacizumab (Avastin)?
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Lonsurf Plus Bevacizumab in Chemorefractory Colorectal Cancer
- September 2, 2019
- Reading time: 2 minutes
From July 3–6, 2019, at the ESMO Gastrointestinal Cancer Congress in Barcelona, Spain, Per Pfeiffer presented the Danish Lonsurf trial results: "Efficacy and safety of trifluridine/tipiracil (Lonsurf) plus bevacizumab combination therapy in patients with chemorefractory colorectal cancer."
Trial Design
The Danish Lonsurf trial was a physician-initiated, randomized controlled trial in patients with colorectal cancer refractory to standard treatments (5-FU, irinotecan, oxaliplatin, and anti-EGFR antibodies such as cetuximab or panitumumab in RAS wild-type patients). Primary endpoint: PFS. Secondary endpoint: OS.
- Lonsurf + bevacizumab combination group (4-week cycles: trifluridine/tipiracil 35 mg/m² twice daily on Days 1–5 and 8–12 + bevacizumab 5 mg/kg every 2 weeks, N=46)
- Lonsurf monotherapy group (4-week cycles: trifluridine/tipiracil 35 mg/m² twice daily on Days 1–5 and 8–12, N=47)
Prior treatment history:
- ≤2 prior regimens: Combination 46% / Monotherapy 42%
- 3 prior regimens: Combination 26% / Monotherapy 28%
- 4 prior regimens: Combination 17% / Monotherapy 17%
- ≥5 prior regimens: Combination 11% / Monotherapy 13%
- Prior bevacizumab: Combination 85% / Monotherapy 77%
Efficacy Results
Median PFS (primary endpoint):
- Combination group: 4.6 months / Monotherapy group: 2.6 months
- Combination group: 55% reduction in disease progression risk (HR 0.45) — significant improvement
Median OS (secondary endpoint):
- Combination group: 9.4 months / Monotherapy group: 6.7 months
- Combination group: 45% reduction in disease progression risk (HR 0.55) — significant improvement
Subgroup analyses of both PFS and OS showed favorable results for the combination group regardless of prior bevacizumab treatment history.
Safety Profile
The combination group showed higher rates of neutropenia and thrombocytopenia compared to monotherapy:
- Neutropenia: Combination 85% / Monotherapy 66%; Grade 3–4: Combination 67% / Monotherapy 38%
- Thrombocytopenia: Combination 39% / Monotherapy 17%
Source: Bevacizumab improves efficacy of trifluridine/tipiracil (TAS-102) in patients with chemorefractory metastatic colorectal cancer: a Danish randomized trial. (World Congress on Gastrointestinal Cancer 2019, Abstract #O-014)
Tags: #ColorectalCancer
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