Capecitabine plus temozolomide (CapTem): An alternative regimen to regorafenib as third-line setting in metastatic colorectal cancer?

The optimal treatment regimens after second line chemotherapy in metastatic colorectal cancer (mCRC) remains unclear. This study aimed to compare the real-life data of regorafenib versus capecitabine plus temozolamide (CapTem) regimen as third-line setting in mCRC.

Between January 2013 and March 2018, data of 358 mCRC patients were retrospectively evaluated. Forty-two mCRC patients who received regorafenib (n:27) or CapTem (n:15) as third-line setting were included.

Median follow-up was 6 months (range: 2.2-29.7). No complete remission was achieved. Disease control rate was 22% and 20% for the regorafenib and CapTem arms, respectively. There was no statistically significant difference for either median overall survival (OS) or progression-free survival (PFS) between the two groups. Median OS was 7 months in the regorafenib group and 6.5 months in the CapTem group (hazard ratio [HR] for death, 0.60; 95% confidence interval [CI] 0.28-1.27; p=0.18), and median PFS was 3.3 months for the patients in the regorafenib group and 3.2 months for those in the CapTem group (HR for disease progression or death, 0.68; 95% CI 0.34-1.33; p= 0.25).

The present study showed that CapTem regimen and regoafenib as third-line setting had similar activity in mCRC. We consider that CapTem regimen might be an alternative treatment option to regorafenib after two lines of chemotherapy in mCRC. However, prospective randomized trials with large number of patients are needed in this issue.