ABSTRACT
BACKGROUND: Regorafenib is considered a standard of care as third-line therapy in metastatic colorectal cancers (mCRCs). MATERIALS AND METHODS: The study was based on a computerized clinical data form sent to oncologists across the country for entry of anonymized patient data. The data entry form was conceived and generated by the coordinating center's (Tata Memorial Hospital) gastrointestinal medical oncologists and disseminated through personal contacts at academic conferences as well as through E-mail to various oncologists across India. RESULTS: A total of 19 physicians contributed data resulting in 80 patients receiving regorafenib who were available for the evaluation of practice patterns. The median age was 55 years (range: 24-75). Majority had received oxaliplatin-based (97.5%), irinotecan-based (87.5%), and targeted therapy (65%), previously. Patients were primarily started on reduced doses of regorafenib upfront (160 mg - 28.8%, 120 mg - 58.8%, and 80 mg - 12.5%). The median duration of treatment (treatment duration) with regorafenib was 3.1 months (range: 0.5-18), while the median progression free survival was 3.48 months (range: 2.6-4.3). Forty-five percent of patients required dose modifications due to toxicities, and the most common were (all grades) hand-foot syndrome (68.8%), fatigue (46.3%), mucositis (37.6%), and diarrhea (31.3%). CONCLUSIONS: Majority of physicians in this collaborative study from India used a lower dose of regorafenib at the outset in patients with mCRC. Despite a lower dose, there was a significant requirement for dose reduction. Duration of treatment with regorafenib as an efficacy end point in this study is similar to available data from other regions as it is the side effect profile.
ABSTRACT
The management of gastrointestinal stromal tumors (GISTs) has been revolutionized in recent years by two major developments: the introduction of imatinib mesylate as a targeted therapeutic agent and the dramatic change in the tumor metabolic activity following successful therapy making in fluorodeoxyglucose (FDG)-PET as the modality of choice for monitoring therapeutic response. In the present communication, we have explored the current role of PET/computed tomography (CT) imaging in GIST on the basis of a brief overview of the published studies and our experience on the subject gained in a large tertiary care setting. There is now convincing evidence that serial PET study is more sensitive and reliable for determining treatment response to imatinib mesylate in patients of GIST, when compared with only conventional CT monitoring. This modality also appears to be of potential value in initial disease evaluation including prediction of malignant potential in recently diagnosed GIST and in selection of optimal dose of imatinib for therapy. The findings of detection of disease recurrence on discontinuing imatinib and acquired resistance to imatinib provide insight into the issue of therapeutic endpoint definition. On the basis of the experience gained in recent times, the future potential of this powerful modality in this setting is hypothesized.