Opinion
Video
Overcoming Barriers in mCRC: Access, Adherence, and the Patient Voice
Panelists discuss how common barriers to implementing trifluridine/tipiracil plus bevacizumab combination therapy include complex pill burden management with multiple bottle strengths that can confuse patients during dose reductions, procedural complications requiring bevacizumab holds that patients sometimes fail to disclose in advance, and hypertension management challenges that create patient anxiety about treatment delays, while emphasizing that adherence support strategies include close monitoring with biweekly visits, written dosing calendars, alternative five-day dosing schedules aligned with infusion timing, and incorporating patient-reported outcomes into shared decision-making to optimize treatment success despite these practical barriers.
Common barriers to implementing trifluridine/tipiracil plus bevacizumab combination therapy in clinical practice include complex pill burden management, procedural complications, and hypertension control challenges. The oral medication component presents significant complexity with two different pill strengths requiring careful counting and combination to achieve proper dosing, which becomes even more complicated with dose reductions when patients may have unused pills or extra bottles. Some patients prefer intravenous infusions over oral medications due to concerns about dosing errors or self-administration mistakes. Bevacizumab-related barriers include managing perioperative holds for procedures, with patients sometimes failing to disclose planned dental extractions or surgeries until after drug administration, creating management challenges.
Hypertension management represents a particularly significant barrier, as many patients already have underlying hypertensive comorbidities that become exacerbated with bevacizumab therapy. Achieving blood pressure control can be time-consuming, leading to patient anxiety about treatment delays when their blood pressure exceeds acceptable parameters for drug administration. Patients often experience anticipatory anxiety about clinic visits, requesting time to relax before blood pressure measurements to avoid treatment postponement. Despite these challenges potentially impacting patient willingness to continue therapy, clinicians emphasize that the regimen offers superior overall survival and quality of life benefits compared to alternative options.
Patient-reported outcomes and adherence support strategies have become increasingly important in treatment selection and optimization. While quality of life data for these regimens has historically been limited, recent studies providing patient perspective information help inform shared decision-making discussions and reassure both patients and providers about treatment appropriateness. Adherence support includes close monitoring with visits every two weeks initially, written dosing calendars to help navigate complex oral medication schedules, and alternative dosing strategies such as five-day regimens every two weeks to align with bevacizumab infusion schedules. This personalized approach helps minimize dosing confusion and reduces the risk of adverse events from medication errors, with some clinicians utilizing retrospective data on alternative dosing regimens to customize treatment plans for individual patient needs.
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