Using the Morbidity and Mortality Conference Model to Explore and Improve Community-Based Oncology Care (Video Program)Side effects and dose adjustments with regorafenib and TAS-102
4:46 minutes.
TRANSCRIPTION:
DR LOVE: How did you think through whether to use regorafenib or TAS-102 in this particular lady? DR CHEN: For her it was relatively straightforward because when we put her on the regorafenib, TAS-102 was not approved yet. DR LOVE: Okay. DR CHEN: So that actually was straightforward. Yes. DR LOVE: So she went on regorafenib. And what was the dose that you started with? DR CHEN: She was one we did start out at full dose but quickly tapered down. DR LOVE: So you gave her the 160. And when did you see her or hear from her again? DR CHEN: I saw her 2 weeks later. DR LOVE: And was she having problems? DR CHEN: She was. DR LOVE: What was going on? DR CHEN: Asthenia. Starting having some hand-foot syndrome as well. DR LOVE: But not super sick at that point? DR CHEN: Not super sick at that point, but we did taper it down. DR LOVE: I’ve heard people like Axel and Tony Saab, who’ve done a lot of work with this, say you ought to be touching base with the patient at a week — DR HECHT: Always. DR LOVE: — even by phone. DR HECHT: I always have patients come back a week later just for follow-up. DR LOVE: Or talk to them? Because that’s how quickly you — DR HECHT: Usually I like to bring them in, but yes. DR LOVE: When you saw her at 2 weeks, in retrospect, had she already had the problem for a few days or a week? DR CHEN: A few days, yes. A few days. DR LOVE: So you dropped the dose down? DR CHEN: That’s right. DR LOVE: And then what happened? DR CHEN: Well, she was on the regorafenib for 3 months, and — DR LOVE: And how did she feel during that time in terms of the regorafenib? Any tolerability issues? DR CHEN: She had hand-foot syndrome, which was better after we dose reduced. DR LOVE: You went down to 120? DR CHEN: We went down to 120, and then we went down to 80. DR LOVE: And that’s where she stayed, at 80? DR CHEN: That’s right. That’s what she stayed on. DR HECHT: And how long was she on, total? DR CHEN: She was on it for 3 months, total. DR HECHT: So really she was stable disease at the first scan, or did you do the first scan at 3 months, or — DR CHEN: Stable disease at the first scan. And after that, progressed. DR HECHT: Better than many. DR CHEN: Yes. DR LOVE: And globally, how did she feel? What was she doing at that time? DR CHEN: She has a lot of family, good family support. And she always had people visiting her or going to different states to visit her family, her children, her grandchildren. So she had quite a full life. And it was concentrated on a lot of the family events. DR LOVE: How did she find her quality of life on regorafenib? It’s interesting. We did videos of patients for the ASCO GI meeting last year, and we interviewed this one woman — and people think so much about the toxicity of regorafenib — and she was just on and on and on about how she hated irinotecan so much and how great it was to be on a pill. And she was, actually, doesn’t have that many. And we think so much about the mucositis. We don’t realize when they come out of a long history of chemo, in a way, it’s kind of nice for them to take a pill. How did she find that transition? DR CHEN: I think the fatigue and the hand-foot syndrome did affect her. But when we dose-reduced, it was tolerable. So she was able to enjoy her family events. DR LOVE: It looks like she’s already had 4 years of IV chemotherapy. DR HECHT: But that’s also telling you biology. DR CHEN: Exactly. DR HECHT: There’s a lot of biology in here. By definition, this person who presented and then went for a long period of time without having recurrent disease has good biology. And just like in basketball, you can’t teach height. You hope for good biology. And this person had — DR LOVE: Maybe she had anti-angiogenic biology. Maybe that’s why — DR HECHT: Yes. DR LOVE: — the rego — even aflibercept, she was on for 4 months. DR HECHT: There are people whose tumors are different. And if you look at the older trials with drugs like bevacizumab, there’s that tail of the curve of people who did really, really well. DR LOVE: So did she have symptomatic progression or just imaging? DR CHEN: She had imaging progression. But by the time she was on regorafenib, she had been treated for a long time. Her performance status was declining. She was having a lot more fatigue, decreased appetite. So when she progressed on that, we started her on the TAS-102, but it was very short. DR LOVE: It was approved by then? DR CHEN: It was just approved. I think it was — DR LOVE: Wow! Interesting. DR CHEN: — approved and she progressed, so we got her onto it within about a couple of weeks. DR LOVE: I see she was only on it for a couple of months. DR CHEN: Yes. DR LOVE: But during those couple of months, any tolerability issues, any cytopenias? DR CHEN: No. I think she tolerated that fairly well. She did not respond to it. |