Indication
Colorectal cancer, metastatic
Dose
Colorectal cancer, metastatic
- Dose – Oral: 5 mg once daily on days 1 to 21 out of every 28 days until disease progression or unacceptable toxicity
Supplied
Available as 1 and 5 mg capsules. Capsules should NOT be opened. Store at room temperature in original packaging.
Pharmacological Category
Multi-targeted TKI (tyrosine kinase inhibitor) which includes action as a Vascular Endothelial Growth Factor (VEGF) Inhibitor
Administration
Take with or without food
Missed Dose
If a dose is missed, patients should be instructed to take it as soon as they can if it is within 12 hours of the missed dose. If it is over 12 hours since the missed dose, patients should skip the missed dose and resume with the next scheduled dose.
Adverse Effects
Common: Hypertension, Hand-foot skin reaction, Abdominal pain, Anorexia, Diarrhea, Stomatitis, Proteinuria, Decreased albumin, Decreased electrolytes (calcium, magnesium, potassium, sodium), Serum creatinine increase, Hypercholesterolemia, Hypothyroidism, Glucose increase, Hypertriglyceridemia, Increases in liver transaminases, Bilirubin increase, Fatigue, Asthenia.
Less Common: Uric acid increase, Thrombocytopenia, Hemorrhage, Prolonged partial thromboplastin time, Infection, Voice alterations, Arthralgia, Skin rash, Gastrointestinal perforation, hemorrhage, or fistula, Pancreatitis, Posterior reversible encephalopathy syndrome, Impaired wound healing.
The adverse effects listed above are not exhaustive. Please refer to the relevant product monograph for full details.
Monitoring Parameters
Baseline before treatment: CBC & differential, platelets, sodium, potassium, magnesium, creatinine, total protein, albumin, bilirubin, alkaline phosphatase, AST, ALT, urine analysis, TSH, INR.
Before each cycle: CBC & differential, platelets, creatinine, ALT, bilirubin, urine analysis.
If clinically indicated: MUGA scan or echocardiogram, electrolytes, urine analysis, alkaline phosphatase, AST.
Blood pressure: Monitor at baseline, weekly in the first month, at least monthly thereafter, and as clinically indicated.
Drug Interactions
- This drug can impact or be impacted by metabolic enzymes for absorption and excretion. Many drugs can also affect or be affected by these enzymes, so please consult with pharmacy to assess for interactions.
- Current drug interaction databases should be consulted for more information.
Clinical Pearls
- Avoid in pregnancy and lactation.
- Hand-foot skin reaction (HFSR) has been commonly reported with fruquintinib. Follow local guidelines for dose modifications. Treatment with urea cream may be considered for prophylaxis or improvement of HFSR grade in VEGF treated patients.
- Hypertension is common with VEGF inhibitors. Monitor blood pressure closely and manage with antihypertensives and dose hold/reductions. Hypertension should be well controlled prior to starting fruquintinib.
- Bleeding - An increase in the risk of bleeding may occur following fruquintinib administration. If any bleeding event necessitates medical intervention, it is recommended that permanent discontinuation of fruquintinib should be considered.
- Impaired wound healing is associated with VEGF inhibitors, drug may need to be held and restarted if patient requires surgery, discuss with team.
- Avoid starting treatment with fruquintinib in patients with a history of thromboembolic events within the past 6 months, or if they have a history of stroke or transient ischemic attack within the last 12 months.
References
Lexicomp. Fruzaqla Monograph. In: Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc. Accessed May 14th, 2025.
Takeda Canada. Fruzaqla Product Monograph. In: Health Canada, Drug Product Database. Available at: /https://pdf.hres.ca/dpd_pm/00077002. PDF Created September 10th, 2024. Accessed May 14th, 2025.
