Fruquintinib for refractory colorectal cancer in a pre-treated 82-year-old patient achieved a progression-free survival of 25 months: a case report

BACKGROUND: Chemotherapy was recommended as the 1(st) or 2(nd) line standard of care for patients with refractory or metastatic colorectal cancer (mCRC). Extra cautions are needed for elderly patients, because cytotoxic regimens may induce unexpected adverse effects due to their impaired physical condition and tolerability. Currently, there is no evidence for the treatment in elderly patients. This case reports a new ideas to the treatment of elderly mCRC patients. CASE DESCRIPTION: An 82-year-old man was diagnosed with descending colon cancer and underwent radical operation revealed stage IIIB cancer (pT4aN1cM0) in June 2016, followed by adjuvant chemotherapy (6 cycles of XELOX). The disease relapsed in June 2018, and the patient was prescribed Tegafur for 6 months. In December 2018, he was admitted to hospital due to intestinal obstruction with performance status (PS) score of 3 and nutrition score (NRS2002) of 5. According to a multidisciplinary team (MDT) meeting: considering that the adverse effects of front-line treatment are dominated by myelosuppression, the general condition of the patient is currently poor. The patient received fruquintinib as the second-line treatment which was interrupted for one month due to grade 3 hypertension and proteinuria. The restarted dose was reduced from 5 to 3 mg/day and continued until the last follow-up. The disease did not progress during 25-months of Fruquintinib treatment. Unfortunately, the patient was bedridden for a long time after an accidental fall resulting in a pulmonary infection and finally died of respiratory failure in January 2021. CONCLUSIONS: CRC patients with advanced age and poor general condition require MDT meetings and individualized treatment. Despite of an advanced age, poor physical condition, and intense tumor burden, Fruquintinib as the second-line treatment achieved satisfactory disease control in this case. Adverse events could be relieved by dose reduction. Thus, fruquintinib could be a treatment option in refractory elderly CRC patients.