Third-line treatment decision-making for metastatic colorectal cancer - a cross-sectional survey of US community physicians

Sep 23, 2026

Uploaded by Callum

Colorectal cancer is a leading cause of cancer mortality worldwide, with rising metastatic incidence in the US and increasing numbers reaching third-line therapy. Many treatment options have expanded beyond chemotherapy, yet the optimal post–second-line choice and sequencing remain unclear. This cross-sectional survey evaluated treatment preferences and prescribing patterns among US community physicians actively treating metastatic colorectal cancer, focusing on drivers of decision-making and common real-world practice considerations.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Graphical Abstract

Implications for Practice

Introduction

Third-line treatment decision-making for metastatic colorectal cancer: a cross-sectional survey of US community physicians Christopher Cann1, *,, Sophia Zhao2, Nadeem Khan2, Malinda O’Donnell3,, Melina Taylor3, Tehseen Salimi2 1Department of Hematology and Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, United States 2Medical Affairs, Taiho Oncology, Inc, Princeton, NJ 08540, United States Clinical Research Group, Thermo Fisher Scientific, Waltham, MA 02451, United States *Corresponding author: Christopher Cann, MD, Department of Hematology and Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111, USA ([Christopher.Cann@fccc.edu](Christopher.Cann@fccc.edu)) . Abstract Background: Colorectal cancer (CRC) is the second leading cause of cancer-related death worldwide, with increasing incidence in the US. Improvements in disease management and the increasing incidence of patients with metastatic CRC (mCRC) at younger ages has resulted in more patients being treated in the third-line setting. Treatment has evolved beyond chemotherapy with the approval of newer agents, but thereis no consensus on the optimized choice or sequencing post second-line treatment. Identification of the drivers of treatment decisions may provide evidence to guide decision-making, ensuring that patients receive optimal care. The objective of this study was to evaluate treatment preferences and prescribing patterns for third-line mCRC among community-based physicians. Methods: This study surveyed community-based physicians in the US who were actively treating patients with mCRC. Results: Overall survival (OS) and impacts to patient quality of life (QoL) were primary considerations for any third-line treatment for mCRC. Physicians considered OS and progression-free survival (PFS) as extremely important factors when making third-line treatment decisions. Most physicians selected trifluridine-tipiracil (FTD-TPI) combined with bevacizumab as their first treatment choice for third-line mCRC (60%), compared to regorafenib (12%), FTD-TPI monotherapy (8%), capecitabine (8%), and fruquintinib (6%) . Physicians identified fatigue, neutropenia, and hand-foot syndrome as the most challenging adverse events (AEs) to manage, while hand-foot syndrome and allergic reactions were AEs that would most likely lead physicians to discontinue treatment. Conclusion: These findings highlight the third-line treatment preferences and prescribing patterns of community-based physicians who are actively treating patients with mCRC. Key words: metastatic colorectal cancer; trifluridine-tipiracil; regorafenib; fruquintinib; physician preference; prescribing patterns. Received: 21 July 2025; Accepted: 22 January 2026. © The Author(s) 2026. Published by Oxford University Press. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ([https://creativecommons.org/](https://creativecommons.org/)[ ](https://creativecommons.org/)[licenses/by-nc/4.0/](licenses/by-nc/4.0/)), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [reprints@oup.com](reprints@oup.com) for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [journals.permissions@oup.com](journals.permissions@oup.com) . 2 The Oncologist, 2026, Vol. 31, No. 3 Graphical Abstract Implications for Practice There is currently no consensus on the optimized choice or sequencing for third-line treatment of mCRC. Identifying the drivers of treatment decisions may provide evidence to help guide decision making, ensuring that patients receive optimal care. Physicians surveyed in this study considered OS and QoL as key factors in driving treatment decision

FAQs

What was the main objective of this study?

To evaluate treatment preferences and prescribing patterns for third-line metastatic colorectal cancer among US community-based physicians.

Which factors were most important when physicians chose third-line therapy?

Overall survival and impacts to patient quality of life were primary considerations, with overall survival and progression-free survival described as extremely important.

What adverse events were hardest to manage, and which were most likely to stop treatment?

Fatigue, neutropenia, and hand-foot syndrome were identified as the most challenging adverse events to manage, while hand-foot syndrome and allergic reactions were the adverse events most likely to lead physicians to discontinue treatment.

Sep 23, 2026

Uploaded by Callum