Expert opinion on treatment patterns in metastatic colorectal cancer management in Eastern Europe

Colorectal cancer (CRC) is the third most prevalent malignancy globally and the second leading cause of cancer-related mortality. Approximately 15%-30% of patients are diagnosed with metastatic CRC (mCRC), and despite increasing survival rates, mCRC remains fatal. There are notable variations in the incidence and mortality rates of CRC across European countries, which may be attributed to the differences in lifestyle patterns and variations in cancer diagnosis and management practices. Standard initial treatments for mCRC include chemotherapeutic agents and targeted therapies. This report presents the findings of a virtual meeting held from 21 January to 2 February 2025. The meeting included healthcare professionals from 10 Eastern European countries (Bosnia and Herzegovina, Bulgaria, Croatia, Hungary, Latvia, Lithuania, Montenegro, Romania, Serbia, and Slovenia). The experts shared their opinions on various topics such as the current clinical practice and existing clinical challenges in the treatment of patients with mCRC, factors influencing treatment choices, and the place of fruquintinib therapy in the management of mCRC. The discussion was facilitated using open-ended questions. The primary objective of this article was to provide an overview of the experts' opinions and experiences related to the current treatment approaches to mCRC management, with a focus on fruquintinib in Eastern Europe. The experts identified the need for molecular and genetic profiling, multidisciplinary coordination, limited availability of and access to targeted and newly approved medications, and lack of reimbursement as key challenges in managing patients with mCRC in these regions. The experts also highlighted the importance of patient education and participation in regional and international clinical trials of new therapeutics. They also noted the need for generating real-world evidence on the safety and efficacy of fruquintinib, its comparative efficacy versus other later-line therapies, its efficacy as an earlier line of therapy, and its sequencing in the current treatment practices. Furthermore, despite the lack of direct experience with fruquintinib, most experts acknowledged its potential efficacy as a later-line therapy for mCRC and considered its effectiveness to be comparable to that of other third-line treatments.