Clinical Advances in Hematology & OncologyFruquintinib as Post–Standard Third-Line Therapy in a Patient with mCRC without Targetable Mutations: A Real-World Application of FRESCO Trial Principles

⚠️ Limited Generalizability

A 72-year-old man with KRAS-mutant metastatic colorectal cancer progressed after CAPEOX plus bevacizumab and FOLFIRI, then achieved a rapid hepatic response with third-line fruquintinib and manageable toxicity.

Diagnostic Considerations

• KRAS mutation with no actionable targets limits later-line treatment options
• Third-line therapy prioritizes disease stabilization and quality of life
• FRESCO trials show overall survival up to 9.3 vs 6.6 months
• Progression-free survival approximately 3.7 vs 1.8 months
• No defined sequencing strategy exists among available third-line agents

Practice Pearls

• Initiate treatment planning discussions before second-line progression
• Align therapy selection with prior VEGF exposure and toxicity burden
• Consider oral, non-cytotoxic options to preserve quality of life
• Use shared decision-making to guide later-line treatment selection