Healthcare Resource Utilization (HCRU), Effectiveness and Safety of Trifluridine/Tipiracil in Treatment of Refractory Metastatic Colorectal Cancer in a Portuguese Comprehensive Cancer Center (PCCC)

OBJECTIVES: Trifluridine/Tipiracil(FDT-TPI) is a drug approved for refractory metastatic colorectal cancer(mCRC) treatment. This study aim to assessed HCRU and FDT-TPI clinical outcomes in a real-world(RW) setting.

METHODS: Retrospective cohort study with all mCRC patients(pts) who started FDT-TPI as palliative treatment before 01/11/2022, with follow-up until 30/04/2023. Data was collected from medical/administrative records. Clinical characteristics and HCRU were evaluated using descriptive statistics. Kaplan-Meier method was used for survival analysis. HCRU outcomes included: outpatient and emergency room visits; hospitalizations; complementary diagnostic and therapeutic procedures (CDTs).

RESULTS: The cohort included 196 pts, 65%male, with a median age of 63/yo(23-85). Majority had an ECOG1(62%) and 47% had ≥3 metastatic sites at treatment initiation.

Treatment median cycles was 3. Median PFS was 3.0 months and OS was 6.4 months. In a subgroup analysis stratified by number of metastatic sites (1vs2vs ≥3), median OS was superior in pts with fewer sites involved (9.6 vs 6.8 vs 5.2 months). Disease control rate was 10%. Median time to worsening of ECOG ≥2 was 5.3 months.

Grade>=3 adverse events(AE) occurred in 43% of the pts, the most common were neutropenia(31%) and anemia(8%). No toxic deaths were documented. AE led to dose reductions in 24% of the pts and treatment delays in 55%.

There were a median of 7 medical appointments and 1 CTscans performed during treatment. Proportion of pts admitted in emergency was 54,4%; 29,2% were hospitalized. The mean cost per patient of the prescribed drug was 8280,06€.

CONCLUSIONS: Given the high prevalence of mCRC pts, the treatment is likely to result in potential high budget impact for hospitals. Our study showed more frequent dose reduction, worse disease control rate and a safety profile with fewer grade>=3 AE reported compared to clinical trials. Survival benefits and time to worsening of performance status were comparable to the ones reported.