Health-Related Quality of Life Outcomes in Metastatic Colorectal Cancer: Takeaways from the SUNLIGHT Study

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John L. Marshall, MD: We could spend the next hour on quality of life and colon cancer. There are a lot of ways the disease, the treatment, and the consequences of all sorts of things impact the quality of life for patients. They hate ostomies. Who wouldn’t? Cancer hurts, so there’s a pain symptom issue, including the adverse effects of the medicine—neuropathy, fatigue, appetite change, bowel alteration, the list goes on. The process of coming to get treatment on a regular basis can impact their quality of life. Our IV [intravenous] drugs, you could argue, have a worse quality of life than our oral ones. So you come at it from all different angles. [There are] lots of ways quality of life can be impacted.

First, the SUNLIGHT trial is taking 2 approved drugs. A lot of us were already putting them together based on an earlier study. But this was the formal phase 3 study of Lonsurf, TAS-102, and trifluridine-tipiracil—which are all the same medicine—vs Lonsurf [trifluridine-tipiracil] plus bevacizumab in the refractory metastatic setting. We all know that these data were positive. They showed that the VEGF beyond progression bevacizumab beyond progression strategy did improve progression-free survival and overall survival and quickly became a new instant standard for this third-line refractory patient.

But what was presented at the most recent meeting was how patients felt during treatment. Patients, as part of this clinical trial, were taking questionnaires: how’s life? What’s going on? [What are the] adverse effects and all the different things that affect you? This is what was presented. It’s an important part of any major practice-changing clinical trial, but this 1 showed clearly that keeping bevacizumab going on top of the Lonsurf did not negatively impact quality of life in any way. Talk about getting IVs. Sometimes IV medicines have adverse effects; bevacizumab, not so much. Remember that almost all these patients had had prior bevacizumab, so they’ve experienced it before. The good news is that this doublet combination, which has quickly become a standard, did not have a big negative impact on quality of life compared with patients getting a single-agent oral therapy.

Transcript edited for clarity.