Dr. Bekaii-Saab on the Impact of Regorafenib in CRC

Tanios Bekaii-Saab, MD, professor of medicine, Mayo Clinic, discusses the impact of regorafenib (Stivarga) on the treatment of patients with colorectal cancer (CRC).

The Japanese study REVERCE was a randomized phase II study that investigated a question that originated in the CONCUR study. CONCUR was a study with regorafenib in an Asian population, but due to lack of resources, many patents did not go through every biologic agent before receiving regorafenib. The study was more significant than the CORRECT study, as the survival and progression-free survival (PFS) were much more impressive, says Bekaii-Saab.

Therefore, the REVERCE study asked whether regorafenib can be given to patients with RAS wild-type tumors before having to go to onto cetuximab (Erbitux), versus starting with cetuximab and then bringing in regorafenib. It was a practical question, and the primary endpoint was survival, says Bekaii-Saab. If a patient received regorafenib first and then went to cetuximab, the difference in survival was 6 months, which was statistically significant as it met the primary endpoint. Regarding PFS, it was confirmed that the benefit of regorafenib is increased when used before cetuximab rather than after. Interestingly, cetuximab does not lose effect across lines of therapy, while regorafenib does.