Fruquintinib on the PBS

Fruquintinib has been listed on the Pharmaceutical Benefits Scheme (PBS) for the treatment of metastatic colorectal cancer. Eligibility requires that patients have either previously received, or are not suitable for, treatment with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy, as well as an anti-vascular endothelial growth factor (VEGF) agent and an anti-epidermal growth factor receptor (EGFR) agent for this condition.

Fruquintinib is a highly selective oral tyrosine kinase inhibitor of VEGF receptors 1, 2, and 3. These receptors play an important role in angiogenesis associated with tumour growth and metastasis. The FRESCO-2 study investigated the efficacy and safety of fruquintinib in patients with heavily pretreated metastatic colorectal cancer. Fruquintinib was associated with significant and clinically meaningful benefit in overall survival (OS). Median OS was 7.4 months in the fruquintinib group and 4.8 months in the placebo group (HR 0.66; 95% CI 0.55-0.8; p<0.0001). Median progression-free survival was also improved (3.7 months vs 1.8 months; HR 0.32; 95% CI 0.27-0.39; p<0.0001).

Fruquintinib is administered once daily for the first 21 days of each 28-day cycle. Capsules should be swallowed whole and may be taken without regard to meals. Therapy is continued until disease progression or unacceptable toxicity occurs. Common adverse effects include fatigue, hypertension, stomatitis, diarrhoea, and hypothyroidism. Serious adverse events include haemorrhage and gastrointestinal perforation. In the FRESCO-2 study, asthenia was the most frequent reason for discontinuation.