# SUNLIGHT: trifluridine-tipiracil plus bevacizumab in refractory metastatic colorectal cancer

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

## TL;DR

Adding bevacizumab to the oral chemotherapy trifluridine-tipiracil lengthened survival by about three months in patients with colorectal cancer that had already been treated with two regimens, making the combination the standard third-line treatment.

## Summary

Phase 3 trial of 492 patients with metastatic colorectal cancer after two prior regimens randomised to trifluridine-tipiracil with or without bevacizumab.

Median overall survival was 10.8 versus 7.5 months (hazard ratio 0.61) and median progression-free survival 5.6 versus 2.4 months, with a longer time to worsening performance status and no unexpected toxicity.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- 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 vs 7.5 months; hazard ratio 0.61.; Median progression-free survival 5.6 vs 2.4 months.
- What it means: Trifluridine-tipiracil plus bevacizumab is now the preferred third-line option for most patients regardless of KRAS status, including KRAS G12C tumours once targeted therapy is exhausted.
- Caveats: Open-label; benefit was seen regardless of prior bevacizumab exposure but subgroup sizes were limited.

## Sources

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

## Connected records

- cancers: [KRAS G12C-mutant colorectal cancer](https://onco.cc/cancers/kras-g12c-colorectal/)
- drugs: [Bevacizumab](https://onco.cc/drugs/bevacizumab/)
- trials: [SUNLIGHT](https://onco.cc/trials/sunlight/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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