# Fruquintinib

Source: https://onco.cc/drugs/fruquintinib/  
OnCo record `fruquintinib` (Treatment). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A Chinese-discovered pill that blocks the blood-vessel receptors, approved in 2023 for bowel cancer after all standard treatments.

## Summary

Fruquintinib is an ATP-competitive inhibitor of VEGFR1, 2 and 3 with little activity on other kinases, discovered in China, that starves tumours of new blood vessels with fewer off-target effects than regorafenib. It is used for refractory metastatic colorectal cancer after fluoropyrimidine, oxaliplatin, irinotecan, anti-VEGF and, where appropriate, anti-EGFR therapy, taken 5 mg once daily for 21 days of a 28-day cycle. FRESCO (China, 2018) and FRESCO-2 (global, 2023) showed an overall survival benefit, 7.4 versus 4.8 months in FRESCO-2 (HR 0.66); FDA approval followed in November 2023 and EU approval in 2024. It is better tolerated than regorafenib; hypertension, hand-foot syndrome, proteinuria and hypothyroidism are the main toxicities. There is no head-to-head trial against regorafenib. For a newcomer, it is a late-line bowel cancer pill that adds a few months with manageable side effects.

## Fields

- Kind: Treatment
- Status: approved
- Last checked: 2026-09-07
- Brand: Fruzaqla
- Modality: Small-molecule kinase inhibitor (VEGFR1-3)
- Mechanism: ATP-competitive inhibition of VEGFR1, 2, and 3 tyrosine kinases.
- Approvals: China 2018: Refractory mCRC (FRESCO); US 2023: Refractory mCRC after fluoropyrimidine, oxaliplatin, irinotecan, anti-VEGF, and anti-EGFR if appropriate; EU 2024: Previously treated metastatic colorectal cancer; England (NICE) 2025: Metastatic colorectal cancer at third line or later, only when trifluridine-tipiracil with bevacizumab is unsuitable
- Dosing: Oral; 5 mg once daily, days 1-21 of a 28-day cycle

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Fruquintinib
- FDA approval summary, Clinical Cancer Research: https://aacrjournals.org/clincancerres/article/30/15/3100/746597/FDA-Approval-Summary-Fruquintinib-for-the
- NICE TA1079: fruquintinib for previously treated metastatic colorectal cancer: https://www.nice.org.uk/guidance/ta1079
- EMA Fruzaqla: https://www.ema.europa.eu/en/medicines/human/EPAR/fruzaqla

## Connected records

- cancers: [BRAF V600E-mutant colorectal cancer](https://onco.cc/cancers/braf-v600e-colorectal/), [Colorectal cancer](https://onco.cc/cancers/colorectal/), [KRAS G12C-mutant colorectal cancer](https://onco.cc/cancers/kras-g12c-colorectal/)
- technologies: [Anti-angiogenic therapy](https://onco.cc/technologies/antiangiogenic/), [Small-molecule kinase inhibitors](https://onco.cc/technologies/kinase-inhibitors/)
- targets: [VEGF / VEGFR](https://onco.cc/targets/vegf/)
- companies: [AskGene Pharma](https://onco.cc/companies/askgene-pharma/), [Hutchmed](https://onco.cc/companies/hutchmed/), [Takeda](https://onco.cc/companies/takeda/)
- trials: [- IKF/AIO-QUINTIS - Evaluating Fruquintinib in Combination With Tislelizumab in Microsatellite Stable / Proficient Mismatch Repair (MSS/pMMR) Metastatic Colorec](https://onco.cc/trials/nct06856837/), [A Clinical Study of Iparomlimab and Tuvonralimab Combined With Fruquintinib and Heterogeneous Radiotherapy Versus Fruquintinib as Third-Line and Subsequent-Line](https://onco.cc/trials/nct07502014/), [A Clinical Study on the Efficacy and Safety of Fruquintinib in Combination With PD-1 Monoclonal Antibody and Chidamide in Refractory MSS Metastatic Colorectal C](https://onco.cc/trials/nct06979908/), [A Multicenter, Phase Ib/II Clinical Trial to Evaluate the Efficacy and Safety of Concurrent Combination Therapy of S-531011 Plus Fruquintinib or S-531011 Plus F](https://onco.cc/trials/nct07591597/), [A Phase Ib/II Study of HDM2017 in Combination With Standard of Care in Advanced Colorectal Cancer](https://onco.cc/trials/nct07621159/), [A Phase II Clinical Study of Aipalolitovorelizumab (QL1706) Combined With Fruquintinib in the Treatment of Immunodominant pMMR/MSS Metastatic Colorectal Cancer](https://onco.cc/trials/nct07229872/), [A Phase II Clinical Study of the Efficacy and Safety of Tislelizumab Combined With Fruquintinib and Chidamide in the Treatment of Unresectable or Advanced Micro](https://onco.cc/trials/nct06218888/), [A Prospective, Open-label, Single-arm Phase II Clinical Study of Fruquintinib Combined With S-1 for the Treatment of Metastatic Colorectal Cancer.](https://onco.cc/trials/nct06746545/), [A Randomized Phase 2 Trial of Fruquintinib and TAS-102 as Compared to Fruquintinib in Patients With Refractory Advanced/Metastatic Colorectal Cancer](https://onco.cc/trials/nct06992258/), [A Study Comparing BL-M07D1 With Physician's Choice Therapy in Patients With HER2 IHC3+ Advanced Colorectal Cancer Who Failed Prior Treatment With Oxaliplatin, F](https://onco.cc/trials/nct07730489/), [A Study of ASKG915 in Patients With Selected Advanced Solid Tumors.](https://onco.cc/trials/nct05867420/), [A Study of Fruquintinib Plus FOLFIRI as Second-Line Treatment for Participants With Metastatic Colorectal Cancer (FRUITFUL)](https://onco.cc/trials/nct07011576/), [A Study of Tucidinostat in Combination With Sintilimab and Bevacizumab in MSS/pMMR Colorectal Cancer Patients](https://onco.cc/trials/nct06497985/), [A Study to Explore the Third-line Treatment of Fruquintinib Combined With Serplulimab in Advanced Non-liver-limited Metastatic Colorectal Cancer: a Single-cente](https://onco.cc/trials/nct05954429/), [A Study to Test DSP107 in Combination With Atezolizumab in Comparison With Fruquintinib as a New Treatment for Colorectal Cancer.](https://onco.cc/trials/nct07235293/), [ADG126 in Combination With Pembrolizumab in Patients With Advanced/Metastatic Solid Tumors](https://onco.cc/trials/nct05405595/), [Amplitude-Modulated Radiofrequency Electromagnetic Fields (AM RF EMF) in Combination With Fruquintinib in Refractory Metastatic Colorectal Cancer](https://onco.cc/trials/nct07130903/), [Cadonilimab Combined With Fruquintinib and SBRT as Athird-line and Posterior Line Treatment in Patients With MSS CRC](https://onco.cc/trials/nct06168786/), [FRESCO](https://onco.cc/trials/fresco/), [FRESCO-2](https://onco.cc/trials/fresco-2/), [Fruquintinib and Pirfenidone in Combination With Anti-PD-1 Antibody in Advanced or Metastatic pMMR/MSS Colorectal Carcinoma](https://onco.cc/trials/nct06484153/), [Fruquintinib In Patients With Metastatic Colorectal Cancer Refractory to Standard Chemotherapies in South Korea Patients (FIRST-K)](https://onco.cc/trials/nct07510932/), [Fruquintinib Plus Anti-EGFR Antibody for Third-Line Treatment of RAS Wild-Type mCRC](https://onco.cc/trials/nct07724223/), [Fruquintinib Versus Bevacizumab Plus Chemotherapy in Second-Line RAS-Mutant Metastatic Colorectal Cancer (FRU-RAS)](https://onco.cc/trials/nct07362836/), [Fruquintinib vs Bevacizumab Combined With Irinotecan Liposome and Capecitabine as Second-Line Therapy for Advanced Metastatic Colorectal Cancer](https://onco.cc/trials/nct07051785/), [Fruquintinib With or Without HAI-FOLFOX for Refractory Colorectal Cancer](https://onco.cc/trials/nct06441565/), [Glumetinib Combined With Fruquintinib in the Treatment of MET Amplification or Protein Overexpression in Third-Line Unresectable Metastatic Colorectal Cancer](https://onco.cc/trials/nct06980532/), [Injection of SHR-A1811 Versus Physician Choiced Treatment in Patients With Advanced Colorectal Cancer Who Had Failed to Respond to Oxaliplatin, 5-fu, ](https://onco.cc/trials/nct06199973/), [Neoadjuvant Fruquintinib Plus Tislelizumab Combined With mCapeOX Versus CapeOX for Mid-high pMMR/MSS Locally Advanced Rectal Cancer](https://onco.cc/trials/nct06443671/), [Phase Ib/II Study of QL1706 + Fruquintinib + SCRT vs. Standard Third-Line Therapy in Unresectable Liver-Metastatic pMMR/MSS Colorectal Cancer: Safety, Tolerabil](https://onco.cc/trials/nct07353268/), [Safety and Efficacy of Fruquintinib Plus Chidamide and Sintilimab in the Third and Later Line Treatment of MSS/pMMR Metastatic Colorectal Cancer](https://onco.cc/trials/nct06685276/), [Second-line Doublet Chemotherapy (FOLFOX or FOLFIRI) Plus Fruquintinib Versus Doublet Chemotherapy (FOLFOX or FOLFIRI) Plus Bevacizumab in Metastatic Colorectal](https://onco.cc/trials/nct07150403/), [SHR-3821 in Advanced Colorectal Cancer: an Exploratory Study](https://onco.cc/trials/nct07515820/), [Study of Fruquintinib Plus Sintilimab for Treatment of Advanced Endometrial Cancer](https://onco.cc/trials/nct06584032/), [Study of the Monoclonal Antibody IMT-009 in Patients With Advanced Solid Tumors or Lymphomas](https://onco.cc/trials/nct05565417/), [Vitamin E Combined With Fruquintinib and Tislelizumab in Microsatellite Stabilized Metastatic Colorectal Cancer Patients](https://onco.cc/trials/nct05771181/)
- people: [Jin Li](https://onco.cc/people/li-jin-fuscc/), [Rui-Hua Xu](https://onco.cc/people/xu-rui-hua/), [Tae Won Kim](https://onco.cc/people/kim-tae-won/), [Weiguo Su](https://onco.cc/people/su-weiguo/)
- key papers: [Fruquintinib versus placebo in patients with refractory metastatic colorectal cancer (FRESCO-2)](https://onco.cc/key-papers/paper-dasari-fresco-2-fruquintinib-lancet-2023/)
- terms: [Colorectal cancer drugs in England: what NICE has recommended](https://onco.cc/terms/colorectal-uk-drug-access/)
- pathways: [Colorectal cancer (KEGG map)](https://onco.cc/pathways/colorectal-cancer-signalling/), [The angiogenic switch & tumour vessels](https://onco.cc/pathways/angiogenic-switch/)

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