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**Chapter 6**

**Abstract**

of adverse events.

**1. Introduction**

Cancer Patients

*Aneta L. Zygulska*

Further Therapeutic Options in

In this paper, currently available systemic treatment options (regorafenib, trifluridine/tipiracil, re-challenge chemotherapy, mitomycin C plus capecitabine) for pretreated patients with metastatic colorectal cancer are discussed and compared in terms of their efficacy and safety profiles. Treatment of these patients has remained a challenge for oncologists. The evidence from clinical trials is encouraging. Knowledge of response biomarkers and/or prognostic factors may be helpful in the identification of patients who could benefit most from the treatment. Adequate medication compliance can be achieved due to awareness of toxicity risk among both physicians and cancer patients and appropriate prevention and management

**Keywords:** metastatic colorectal cancer, regorafenib, trifluridine/tipiracil,

To this date, management of heavily pretreated patients with metastatic colorectal cancer, who present with good performance status and adequate organ function reserve, constituted a challenge for oncologists. However, two anticancer therapies dedicated for this specific group of patients became available nowadays. One of them is regorafenib, an oral inhibitor of protein kinases associated with angiogenesis. Another one is trifluridine/tipiracil (TAS-102), an orally administered combination of a thymidine-based nucleic acid analog, and tipiracil hydrochloride, a thymidine phosphorylase inhibitor. Treatment with both anticancer agents contributed to a significant improvement of overall survival (OS) and progressionfree survival (PFS) in randomized III phase studies of Caucasian (CORRECT and TERRA) and Asian patients (CONCUR and RECOURSE). Recently, clinical benefits associated with administration of both drugs and good tolerability thereof were also confirmed in an observational study, REGOTAS. The aim of currently ongoing trials is to evaluate the efficacy and safety of regorafenib and TAS-102 combined with other anticancer drugs in metastatic colorectal cancer patients. While preliminary results of some of those studies seem promising, more evidence is needed to

Another treatment option in metastatic colorectal cancer is re-induction of previously used chemotherapy with oxaliplatin- or irinotecan-based regimens.

re-challenge chemotherapy, mitomycin C plus capecitabine

formulate any clinically relevant conclusions.

Heavily Pretreated Colorectal
