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Published online: 2024-02-05

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Trifluridine/tipiracil (FTD/TPI) in metastatic colorectal cancer treatment

Patryk S. Michel1, Marek Jankowski1, Dawid Sigorski2, Tomasz Kubiatowski3

Abstract

Metastatic colorectal cancer (mCRC) remains a formidable health challenge that needs novel therapeutic approaches. Trifluridine/tipiracil (FTD/TPI), an oral cytostatic antimetabolite drug, has emerged as a promising option in mCRC management. Trifluridine/tipiracil’s mechanism involves incorporating trifluridine into DNA, impeding cell proliferation, and inhibiting thymidine synthase. Clinical investigations underscore its efficacy as both monotherapy and polytherapy. Phase II trials in Japan and a significant multicenter phase III trial (RECOURSE) globally established FTD/TPI’s superiority in terms of overall survival (OS) and progression-free survival (PFS) compared to placebo in heavily pretreated mCRC patients. White blood cells, platelet count, lactate dehydrogenase, alkaline phosphatase, carcinoembryonic antigen, chemotherapy-induced neutropenia, and multiple metastatic sites were determined as potential prognostic factors in FTD/TPI treatment. Intriguingly, recent studies demonstrated that specific KRAS mutations (G12 vs. G13) may potentially guide personalized treatment strategies for achieving better therapeutic outcomes and decreasing drug toxicity. Thanks to clinical trials and real-world studies, the role of FTD/TPI in personalized treatment approaches continues to evolve, with ongoing research poised to unlock further its therapeutic potential.

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