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A Chinese-discovered pill that blocks the blood-vessel receptors, approved in 2023 for bowel cancer after all standard treatments.
Fruquintinib is an ATP-competitive inhibitor of VEGFR1, 2 and 3 with little activity on other kinases, discovered in China, that starves tumours of new blood vessels with fewer off-target effects than regorafenib. It is used for refractory metastatic colorectal cancer after fluoropyrimidine, oxaliplatin, irinotecan, anti-VEGF and, where appropriate, anti-EGFR therapy, taken 5 mg once daily for 21 days of a 28-day cycle. FRESCO (China, 2018) and FRESCO-2 (global, 2023) showed an overall survival benefit, 7.4 versus 4.8 months in FRESCO-2 (HR 0.66); FDA approval followed in November 2023 and EU approval in 2024. It is better tolerated than regorafenib; hypertension, hand-foot syndrome, proteinuria and hypothyroidism are the main toxicities. There is no head-to-head trial against regorafenib. For a newcomer, it is a late-line bowel cancer pill that adds a few months with manageable side effects.
ATP-competitive inhibition of VEGFR1, 2, and 3 tyrosine kinases. Connects to VEGF / VEGFR.
1.Fruquintinib enters blood-vessel cells and binds VEGFR kinases
Source: www.accessdata.fda.gov/drugsatfda_docs/label/2023/217564s000lbl.pdf. Doses are for orientation; the current label governs.
Oral, self-administered, so it is a Part D drug: covered through a stand-alone Part D plan or Medicare Advantage drug benefit, usually on the specialty tier with 25 to 33% coinsurance until the annual cap ($2,000 in 2025, $2,100 in 2026).
Covered for FDA-labelled and NCCN-listed uses, but almost always behind prior authorisation confirming diagnosis, biomarker and line of therapy; dispensed through a specialty pharmacy. Prior fluoropyrimidine, oxaliplatin, irinotecan and anti-VEGF therapy documented.
Part D out-of-pocket capped at $2,000 (2025) / $2,100 (2026). Medicare patients cannot use manufacturer co-pay cards; charity funds (PAN, HealthWell, CancerCare) and the Extra Help subsidy are the routes.
Sources: Medicare.gov: Drug coverage (Part D) · Medicare.gov: Costs for Medicare drug coverage (annual out-of-pocket cap). Not medical or financial advice; verify with your plan.
Sources: NICE TA1079. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
FRESCO-2
| Region | Year | Indication |
|---|---|---|
| China | 2018 | Refractory mCRC (FRESCO) |
| US | 2023 | Refractory mCRC after fluoropyrimidine, oxaliplatin, irinotecan, anti-VEGF, and anti-EGFR if appropriate |
| EU | 2024 | Previously treated metastatic colorectal cancer · Fruzaqla marketing authorisation issued 20 June 2024. |
| England (NICE) | 2025 | Metastatic colorectal cancer at third line or later, only when trifluridine-tipiracil with bevacizumab is unsuitable · TA1079, published 23 July 2025, with a commercial arrangement; it must be funded in England within 90 days of publication. |
| Adverse event |
|---|
| Hypertension |
| Hand-foot syndrome |
| Proteinuria |
| Hypothyroidism |
Most common grade 3 event. Events listed without rates were not read from a primary source; see the label. Blank cells mean the figure was not sourced, not that it is zero.
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Query for this drug: (TITLE:"Fruquintinib" OR ABSTRACT:"Fruquintinib" OR TITLE:"Fruzaqla" OR ABSTRACT:"Fruzaqla") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Fruquintinib, not a curated reading list.
Shares A Randomized Phase 2 Trial of Fruquintinib and TAS-102 as Compared to Fruquintinib in Patients With Refractory Advanced/Metastatic Colorectal Cancer, ADG126 in Combination With Pembrolizumab in Patients With Advanced/Metastatic Solid Tumors, Injection of SHR-A1811 Versus Physician Choiced Treatment in Patients With Advanced Colorectal Cancer Who Had Failed to Respond to Oxaliplatin, 5-fu, , Tae Won Kim.
Shares Injection of SHR-A1811 Versus Physician Choiced Treatment in Patients With Advanced Colorectal Cancer Who Had Failed to Respond to Oxaliplatin, 5-fu, , A Study Comparing BL-M07D1 With Physician's Choice Therapy in Patients With HER2 IHC3+ Advanced Colorectal Cancer Who Failed Prior Treatment With Oxaliplatin, F, Colorectal cancer drugs in England: what NICE has recommended, The angiogenic switch & tumour vessels.
Shares A Phase II Clinical Study of the Efficacy and Safety of Tislelizumab Combined With Fruquintinib and Chidamide in the Treatment of Unresectable or Advanced Micro, A Clinical Study on the Efficacy and Safety of Fruquintinib in Combination With PD-1 Monoclonal Antibody and Chidamide in Refractory MSS Metastatic Colorectal C, A Study of Tucidinostat in Combination With Sintilimab and Bevacizumab in MSS/pMMR Colorectal Cancer Patients, Safety and Efficacy of Fruquintinib Plus Chidamide and Sintilimab in the Third and Later Line Treatment of MSS/pMMR Metastatic Colorectal Cancer.
Shares FRESCO, Tae Won Kim, KRAS G12C-mutant colorectal cancer, VEGF / VEGFR.
Shares FRESCO-2, VEGF / VEGFR, Anti-angiogenic therapy, Small-molecule kinase inhibitors.
Shares FRESCO-2, VEGF / VEGFR, Anti-angiogenic therapy, Small-molecule kinase inhibitors.
Shares Fruquintinib versus placebo in patients with refractory metastatic colorectal cancer (FRESCO-2), KRAS G12C-mutant colorectal cancer, VEGF / VEGFR, Anti-angiogenic therapy.
Shares Fruquintinib versus placebo in patients with refractory metastatic colorectal cancer (FRESCO-2), VEGF / VEGFR, Anti-angiogenic therapy, Small-molecule kinase inhibitors.