# Trifluridine-tipiracil and bevacizumab in refractory metastatic colorectal cancer (SUNLIGHT)

Source: https://onco.cc/key-papers/paper-prager-sunlight-trifluridine-tipiracil-bevacizumab-nejm-2023/  
OnCo record `paper-prager-sunlight-trifluridine-tipiracil-bevacizumab-nejm-2023` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Adding a cheap old antibody to the refractory-line tablet took median survival from 7.5 to 10.8 months, the largest gain in this setting since the setting existed.

## Summary

Prager, Taieb, Fakih and colleagues randomly assigned, 1:1, adult patients who had received no more than two previous chemotherapy regimens for advanced colorectal cancer to trifluridine-tipiracil plus bevacizumab or trifluridine-tipiracil alone, with overall survival as the primary end point and progression-free survival and safety, including time to worsening of ECOG performance status from 0 or 1 to 2 or more, as secondary end points. A total of 246 patients were assigned to each group.

The commonest adverse events in both groups were neutropenia, nausea and anaemia; no treatment-related deaths were reported.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: colorectal-evidence
- Journal: New England Journal of Medicine
- Year: 2023
- DOI: 10.1056/NEJMoa2214963
- Authors: Prager GW, Taieb J, Fakih M, et al.
- Findings: Median overall survival 10.8 months with the combination against 7.5 months with trifluridine-tipiracil alone: hazard ratio 0.61 (95 percent CI 0.49 to 0.77, p<0.001).; Median progression-free survival 5.6 against 2.4 months: hazard ratio 0.44 (0.36 to 0.54, p<0.001).; Median time to worsening performance status 9.3 against 6.3 months (hazard ratio 0.54, 0.43 to 0.67).; No treatment-related deaths.
- What it means: Trifluridine-tipiracil with bevacizumab is the refractory-line standard, and a reminder that combining two drugs already on the shelf can beat anything new in the same line.
- Caveats: The comparator is trifluridine-tipiracil alone rather than the physician's best choice, which in many countries would have included regorafenib.; Patients had received no more than two previous regimens, so this is an earlier population than RECOURSE or CORRECT.; Funded by the two manufacturers.

## Sources

- N Engl J Med 2023: https://doi.org/10.1056/NEJMoa2214963
- PubMed: https://pubmed.ncbi.nlm.nih.gov/37133585/

## Connected records

- 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/), [Randomized trial of TAS-102 for refractory metastatic colorectal cancer (RECOURSE)](https://onco.cc/key-papers/paper-mayer-recourse-tas-102-nejm-2015/)
- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/)
- fronts: [Chemotherapy](https://onco.cc/fronts/chemotherapy/)
- technologies: [Anti-angiogenic therapy](https://onco.cc/technologies/antiangiogenic/), [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/)
- targets: [VEGF / VEGFR](https://onco.cc/targets/vegf/)
- drugs: [Bevacizumab](https://onco.cc/drugs/bevacizumab/), [Trifluridine/tipiracil](https://onco.cc/drugs/trifluridine-tipiracil/)
- companies: [Servier](https://onco.cc/companies/servier/), [Taiho Pharmaceutical (Otsuka)](https://onco.cc/companies/taiho/)
- terms: [Performance status (ECOG, Karnofsky)](https://onco.cc/terms/performance-status/)
- trials: [SUNLIGHT](https://onco.cc/trials/sunlight/)
- people: [Eric Van Cutsem](https://onco.cc/people/eric-van-cutsem/), [Gerald W. Prager](https://onco.cc/people/gerald-prager/), [Josep Tabernero](https://onco.cc/people/josep-tabernero/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)
- roadmaps: [Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation](https://onco.cc/roadmaps/colorectal-roadmap/)

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