Guillem Argilés, Nuria Mulet, Manuel Valladares-Ayerbes, José M. Viéitez, Cristina Grávalos, Pilar García-Alfonso, Cristina Santos, María Tobeña, Beatriz García-Paredes, Manuel Benavides, María T. Cano, Fotios Loupakis, Mercedes Rodríguez-Garrote, Fernando Rivera, Richard M. Goldberg, Chiara Cremolini, Jaafar Bennouna, Fortunato Ciardiello, Josep M. Tabernero, Enrique Aranda, Josep Tabernero, Alfredo Falcone, Richard Goldberg, null Argilés, J. Tabernero, N. Mulet, M.L. Limón, M. Valladares, P. Jiménez, J. Ma Vieitez, C. Grávalos, P. García-Alfonso, C. Santos, D. Páez, M. Tobeña, J. Sastre, B. García Paredes, M. Benavides, E. Aranda, M.T. Cano, F. Loupakis, M. Rguez Garrote, C. Guillén, Ma F. Rivera, J. Safont, S. Hiret, J. Bennouna, D. Pannier, D. Malka, A. Falcone, C. Cremolini, Argilés, Guillem, Mulet, Nuria, Valladares-Ayerbes, Manuel, Viéitez, José M, Grávalos, Cristina, García-Alfonso, Pilar, Santos, Cristina, Tobeña, María, García-Paredes, Beatriz, Benavides, Manuel, Cano, María T, Loupakis, Fotio, Rodríguez-Garrote, Mercede, Rivera, Fernando, Goldberg, Richard M, Cremolini, Chiara, Bennouna, Jaafar, Ciardiello, Fortunato, Tabernero, Josep M, Aranda, Enrique, Tabernero, Josep, Institut Català de la Salut, [Argilés G] Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain. CIBERONC, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. Memorial Sloan Kettering Cancer Center, New York, USA. [Mulet N, Tabernero JM] Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain. CIBERONC, Barcelona, Spain. [Valladares-Ayerbes M] Virgen del Rocío University Hospital and Institute of Biomedicine (IBIS), Sevilla, Spain. [Viéitez JM] Hospital Universitario Central de Asturias, Oviedo, Spain. [Grávalos C] Universitary Hospital 12 de Octubre, Madrid, Spain. [García-Alfonso P] Gregorio Marañón Hospital, Madrid, Spain, and Vall d'Hebron Barcelona Hospital Campus
Purpose: The purpose of this article is to evaluate the safety of two regorafenib dose-escalation approaches in refractory metastatic colorectal cancer (mCRC) patients.Patients and methods: Patients with mCRC and progression during or within 3 months following their last standard chemotherapy regimen were randomised to receive the approved dose of regorafenib of 160 mg QD (arm A) or 120 mg QD (arm B) administered as 3 weeks of treatment followed by 1 week off, or 160 mg QD 1 week on/1 week off (arm C). The primary end-point was the percentage of patients with G3/G4 treatment-related adverse events (AEs) in each arm.Results: There were 299 patients randomly assigned to arm A (n = 101), arm B (n = 99), or arm C (n = 99); 297 initiated treatments (arm A n = 100, arm B n = 98, arm C n = 99: pop-ulation for safety analyses). G3/4 treatment-related AEs occurred in 60%, 55%, and 54% of patients in arms A, B, and C, respectively. The most common G3/4 AEs were hypertension (19, 12, and 20 patients), fatigue (20, 14, and 15 patients), hypokalemia (11, 7, and 10 pa-tients), and hand-foot skin reaction (8, 7, and 3 patients). Median overall survival was 7.4 (IQR 4.0-13.7) months in arm A, 8.6 (IQR 3.8-13.4) in arm B, and 7.1 (IQR 4.4-12.4) in arm C.Conclusions: The alternative regorafenib dosing schedules were feasible and safe in patients with mCRC who had been previously treated with standard therapy. There was a higher nu-merical improvement on the most clinically relevant AEs in the intermittent dosing arm, particularly during the relevant first two cycles. Clinicaltrials.gov identifier: NCT02835924.(C) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).