Preliminary experience of oral fruquintinib-capecitabine as a new maintenance treatment strategy for advanced colorectal cancer in the era of coronavirus disease 2019 (COVID-19): case report and literature review

BACKGROUND: Bevacizumab combined with fluorouracil is the currently recommended maintenance treatment for metastatic colorectal cancer, but the use of bevacizumab needs to be carried out in hospitals, which invisibly increases the risk of patients’ exposure to coronavirus disease 2019 (COVID-19) during the COVID-19 epidemic. Therefore, except of the advantage of convenience, all oral drugs as the maintenance treatment can reduce hospitalization and potential exposure risk during the COVID-19 epidemic, which is worth further exploration. CASE DESCRIPTION: First case was a 49-year-old male with stage IV colon adenocarcinoma and abnormal liver function who was given bevacizumab with FOLFOXIRI (8-cycles), following which his liver function recovered. Oxaliplatin was stopped upon thrombocytopenia development. The patient was finally maintained on oral fruquintinib and capecitabine therapy since November 2020, and has been progression-free for >15 months. Grade 2 leukopenia, neutropenia, and thrombocytopenia; grade 1 terminal nerve injury; and grade 1 hand and foot numbness were observed. The second case was a 48-year-old male with advanced colon cancer who underwent laparoscopic sigmoidectomy. Post-surgery, the patient was commenced on fluorouracil and leucovorin (1-cycle), followed by conversion therapy with cetuximab and chemotherapy (6-cycles). The patient underwent left hemi-hepatectomy, partial hepatectomy of the right lobe, and intraoperative radiofrequency ablation, following which he continued to receive cetuximab and chemotherapy. The patient was maintained on oral fruquintinib and capecitabine since December, 2020 and has been progression-free for >14 months. Grade1 myelosuppression, leukopenia, and neutropenia, grade 2 thrombocytopenia were observed. CONCLUSIONS: This case report based on preliminary evidence advocates oral fruquintinib-capecitabine maintenance treatment as an alternative to bevacizumab-capecitabine standard therapy for CRC patients, especially in the era of COVID-19 epidemic. This scheme can reduce hospitalization and potential COVID-19 contact, and is more convenient than intravenous administration. Which should be further explored in future studies.