Comparing Late-line Treatment Sequence of Regorafenib and Reduced-intensity FOLFOXIRI for Refractory Metastatic Colorectal Cancer

Cheng Chun Tai, Wei Shone Chen, Jeng Kai Jiang, Shung Haur Yang, Huann Sheng Wang, Shih Ching Chang, Yuan Tzu Lan, Chun Chi Lin, Hung Hsin Lin, Sheng Chieh Huang, Hou Hsuan Cheng, Yee Chao, Hao Wei Teng*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background:Both regorafenib and reduced-intensity FOLFOXIRI (riFOLFOXIRI) prolong survival in patients with metastatic colorectal cancer (mCRC). However, the sequence in which they should be administrated first in late-line treatment for refractory mCRC remains unclear.Patients and Methods:This study was a single-center retrospective cohort study that reviewed data from patients at Taipei Veterans General Hospital, Taiwan, with mCRC refractory to fluorouracil, irinotecan, oxaliplatin, cetuximab (wild-type RAS), and bevacizumab. Patients were divided into 2 groups: A regorafenib-first group and a riFOLFOXIRI-first group. The Kaplan-Meier method and log-rank test were used to analyze survival, and a Cox proportional hazards model was used for univariate, multivariate, and subgroup analyses.Results:A total of 136 and 55 patients followed a regorafenib-first or riFOLFOXIRI-first treatment strategy, respectively. At baseline, patient characteristics were similar between the groups, except for younger age in the riFOLFOXIRI-first group. The regorafenib-first group had better overall survival (13.8 vs. 10.7 mo, P=0.038), whereas patients in the riFOLFOXIRI-first group had a better partial response rate (P=0.005) but a higher rate of discontinuation due to adverse effects (P=0.004) and cross-over to regorafenib (P<0.001). Thus, no significant difference was observed in progression-free survival (regorafenib-first strategy: 3.17 mo; riFOLFOXIRI-first strategy: 4.97 mo; P=0.624). Regorafenib-first strategy, sex, and pathology were identified as independent prognostic factors. Subgroup analysis indicated that younger age, better performance status, stage IV disease, and mutant RAS gene favored the regorafenib-first strategy.Conclusion:Treatment with regorafenib-first followed by riFOLFOXIRI resulted in better overall survival when given as late-line treatment for patients with refractory mCRC.

Original languageEnglish
Pages (from-to)28-34
Number of pages7
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
Issue number1
StatePublished - 1 Jan 2020


  • chemotherapy
  • metastatic colorectal cancer
  • regorafenib
  • treatment sequence


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