Fruquintinib (Specialist drug)

How it works

It selectively inhibits VEGFR-1, -2 and -3 tyrosine kinases, blocking VEGF-mediated signalling to suppress tumour angiogenesis and vascular permeability.

Prescribing in practice

• Hypertension is common and can be severe; blood pressure should be controlled before starting and monitored throughout, with dose interruption for uncontrolled or hypertensive crisis.
• Treatment is initiated and supervised by specialists experienced in anticancer therapy, with dosing given in cycles per the SPC.
• It carries risks of haemorrhage, proteinuria, impaired wound healing and gastrointestinal perforation, so withhold around elective surgery and review for relevant symptoms.

Monitoring

Monitor blood pressure, urinary protein, liver function and for bleeding or proteinuria throughout treatment.

Counselling the patient

• Report severe or persistent headache, visual disturbance, black stools or unexpected bleeding promptly.
• Do not stop or alter the dose yourself; attend all monitoring and review appointments.
• Tell the team about any planned surgery or dental procedures in advance.

Evidence & guidelines

Efficacy in refractory metastatic colorectal cancer was demonstrated in the FRESCO and FRESCO-2 randomised controlled trials.