Comment on: “Regorafenib: Start Low and Go Slow”

Excerpt

We read with great interest the day-to day-practice article entitled “Regorafenib: start low and go slow” from S. Tabchi and M. Ghosn published in Targeted Oncology [1]. The authors describe their management of several metastatic colorectal cancer (mCRC) patients who recently received regorafenib in the hematology oncology department of Saint Joseph University in Beirut (Lebanon). The first six mCRC patients were treated with regorafenib according to the standard scheme of 160 mg once daily for the first 21 days of each 28-day cycle, and five of them had an Eastern Cooperative Oncology Group performance status (ECOG-PS) of 2. Due to serious regorafenib-related adverse events requiring hospitalization (mainly diarrhea ± mucositis leading to dehydration), incremental dosing of regorafenib starting from 80 mg up to 120 or 160 mg daily, increasing by 40-mg increments every 5 days, was preferred in order to improve tolerance, and patients were able to reach the 120-mg/day or the recommended 160-mg/day dose more easily. Seven of 12 patients treated according to this method reached the optimal dose (160 mg/day) by the end of the first cycle (C1), one patient reached this dose by the end of C3, and four patients required dose adjustments to 120 mg/day. The maximal dose level was maintained until disease progression for most patients. Of note, Grothey recently published his own clinical practice based on a similar dose escalation protocol, from an 80- or 120-mg daily dose, increasing the dose by 40 mg each week in the event of no significant related adverse events [2]. …