Trifluridine/tipiracil and survival in mismatch repair-deficient metastatic colorectal cancer

Background: While trifluridine/tipiracil (FTD/TPI) is approved for refractory metastatic colorectal cancer (mCRC), its clinical benefit may vary based on molecular and clinical characteristics. Objectives: To identify clinical and molecular factors associated with overall survival (OS) in patients with refractory mCRC treated with FTD/TPI. Design: Retrospective, multicenter study. Methods: A retrospective multicenter cohort study of 591 mCRC patients treated with FTD/TPI was conducted. Cox regression was used to identify independent prognostic factors for overall survival (OS). Results: Median OS was 7.8 months in the overall cohort. Patients with deficient mismatch repair (dMMR) had significantly longer OS than those with proficient MMR ( p = 0.001). Body mass index (BMI) (hazard ratio (HR) = 0.96), neutrophil-to-lymphocyte ratio ⩾3 (HR = 1.94), and dMMR status (HR=0.29) were independent predictors of OS (all p < 0.001). Conclusion: In this retrospective multicenter cohort, MMR status, BMI, and neutrophil-to-lymphocyte ratio (NLR) were identified as factors independently associated with OS among patients with refractory mCRC treated with FTD/TPI. These findings support the integration of molecular and clinical factors for prognostic stratification in later-line treatment settings