Management of refractory metastatic colorectal cancer: consensus recommendations from Italian oncologists

Introduction: Metastatic colorectal cancer (mCRC) constitutes approximately 10% of all cancers globally andranks as the second leading cause of cancer-related deaths. Management of refractory mCRC remains challengingdue to pharmacological resistance and limited effective therapeutic options.Methods: This publication presents insights from a Delphi panel of Italian clinicians regarding mCRC therapeuticapproaches, unmet medical needs, and fruquintinib’s potential clinical utility within existing treatmentalgorithms. The project, guided by four leading Italian oncology experts, involved two survey rounds among 14oncologists, achieving consensus on 15 statements with a 100% response rate.Results: The expert panel identified critical epidemiological patterns in mCRC, with 20-25% of patients requiring further treatment after the failure of third-line therapy. The panel emphasized the clinical significance of fruquintinib’s efficacy and tolerability profile demonstrated in the FRESCO-2 trial. The experts unanimously endorsed fruquintinib as a new standard of care for adult mCRC patients who have progressed through available standard therapies.Conclusions: This recommendation is based on fruquintinib’s observed survival benefit and manageable toxicityprofile, which facilitate improved treatment management and potentially enhance patient quality of life. Thestructured consensus approach validates these recommendations, providing practical guidance for optimizingoutcomes as therapeutic options for mCRC continue to expand in complexity.