Trifluridine/Tipiracil Plus Bevacizumab Versus Regorafenib in Elderly Patients with Refractory Metastatic Colorectal Cancer: A Real-World Comparative Study

Background: Taiwan’s transition to a super-aged society presents challenges in managing elderly patients with refractory metastatic colorectal cancer (mCRC). This study evaluated the real-world effectiveness of trifluridine/tipiracil (FTD/TPI) plus bevacizumab versus regorafenib in this specific geriatric population. Methods: A retrospective study analyzed patients aged ≥ 65 treated between 2019 and 2023. Patients received regorafenib (n = 46) or FTD/TPI plus bevacizumab (n = 35). Primary endpoints included overall survival (OS) and time to treatment failure (TTF). Results: FTD/TPI plus bevacizumab was associated with significantly longer median OS compared to regorafenib (12.5 vs. 6.5 months; p = 0.039). In multivariate analysis, the combination regimen was identified as an independent predictor of favorable TTF (adjusted HR 0.44, 95% CI 0.22–0.91, p = 0.028). Regorafenib was associated with symptomatic toxicities like hand–foot skin reaction (58.7%), while the combination primarily caused asymptomatic neutropenia. Crucially, permanent discontinuation due to adverse events was significantly lower in the combination arm (2.9% vs. 30.4%, p < 0.001), facilitating a higher proportion of patients receiving subsequent systemic therapy (45.7% vs. 17.4%, p = 0.011). Conclusions: FTD/TPI plus bevacizumab is associated with improved survival outcomes and better tolerability than regorafenib. By demonstrating a manageable safety profile and minimizing treatment attrition, this regimen ensures a sustainable continuum of care, representing a favorable therapeutic option for elderly patients.