{"entity":{"id":"paper-prager-sunlight-trifluridine-tipiracil-bevacizumab-nejm-2023","kind":"paper","name":"Trifluridine-tipiracil and bevacizumab in refractory metastatic colorectal cancer (SUNLIGHT)","aka":[],"tldr":"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.\n\nThe commonest adverse events in both groups were neutropenia, nausea and anaemia; no treatment-related deaths were reported.","asOf":"2026-09-24","links":[{"label":"N Engl J Med 2023","url":"https://doi.org/10.1056/NEJMoa2214963"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/37133585/"}],"tags":["colorectal-evidence"],"related":["paper-mayer-recourse-tas-102-nejm-2015","paper-dasari-fresco-2-fruquintinib-lancet-2023"],"cancers":["colorectal"],"sections":["chemotherapy"],"technologies":["antiangiogenic","cytotoxic-chemotherapy"],"targets":["vegf"],"drugs":["trifluridine-tipiracil","bevacizumab"],"companies":["servier","taiho"],"institutions":[],"pathways":[],"terms":["performance-status"],"trials":["sunlight"],"people":["gerald-prager","eric-van-cutsem","josep-tabernero"],"bottlenecks":[],"keyPapers":[],"journals":["nejm"],"dependsOn":[],"notes":[],"journal":"New England Journal of Medicine","year":2023,"doi":"10.1056/NEJMoa2214963","pmid":"37133585","authors":"Prager GW, Taieb J, Fakih M, et al.","paperType":"rct","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."],"whatItMeans":"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."],"changedPractice":true,"participants":492},"route":"/key-papers/paper-prager-sunlight-trifluridine-tipiracil-bevacizumab-nejm-2023/","neighbours":{"paper":[{"id":"paper-dasari-fresco-2-fruquintinib-lancet-2023","kind":"paper","name":"Fruquintinib versus placebo in patients with refractory metastatic colorectal cancer (FRESCO-2)","route":"/key-papers/paper-dasari-fresco-2-fruquintinib-lancet-2023/"},{"id":"paper-mayer-recourse-tas-102-nejm-2015","kind":"paper","name":"Randomized trial of TAS-102 for refractory metastatic colorectal cancer (RECOURSE)","route":"/key-papers/paper-mayer-recourse-tas-102-nejm-2015/"}],"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"}],"section":[{"id":"chemotherapy","kind":"section","name":"Chemotherapy","route":"/fronts/chemotherapy/"}],"technology":[{"id":"antiangiogenic","kind":"technology","name":"Anti-angiogenic therapy","route":"/technologies/antiangiogenic/"},{"id":"cytotoxic-chemotherapy","kind":"technology","name":"Cytotoxic chemotherapy","route":"/technologies/cytotoxic-chemotherapy/"}],"target":[{"id":"vegf","kind":"target","name":"VEGF / VEGFR","route":"/targets/vegf/"}],"drug":[{"id":"bevacizumab","kind":"drug","name":"Bevacizumab","route":"/drugs/bevacizumab/"},{"id":"trifluridine-tipiracil","kind":"drug","name":"Trifluridine/tipiracil","route":"/drugs/trifluridine-tipiracil/"}],"company":[{"id":"servier","kind":"company","name":"Servier","route":"/companies/servier/"},{"id":"taiho","kind":"company","name":"Taiho Pharmaceutical (Otsuka)","route":"/companies/taiho/"}],"term":[{"id":"performance-status","kind":"term","name":"Performance status (ECOG, Karnofsky)","route":"/terms/performance-status/"}],"trial":[{"id":"sunlight","kind":"trial","name":"SUNLIGHT","route":"/trials/sunlight/"}],"person":[{"id":"eric-van-cutsem","kind":"person","name":"Eric Van Cutsem","route":"/people/eric-van-cutsem/"},{"id":"gerald-prager","kind":"person","name":"Gerald W. Prager","route":"/people/gerald-prager/"},{"id":"josep-tabernero","kind":"person","name":"Josep Tabernero","route":"/people/josep-tabernero/"}],"journal":[{"id":"nejm","kind":"journal","name":"New England Journal of Medicine","route":"/journals/nejm/"}],"roadmap":[{"id":"colorectal-roadmap","kind":"roadmap","name":"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","route":"/roadmaps/colorectal-roadmap/"}]}}