In two clinical trials, patients who received fruquintinib (Fruzaqla™) had an overall survival of 7.4 and 9.3 months compared to 4.8 and 6.6 months with placebo, leading to the drug’s November 2023 U.S. Food and Drug Administration (FDA) approval for adults with metastatic colorectal cancer who previously received standard chemotherapy and experienced disease progression. 


Targeted therapy/tyrosine kinase inhibitor 

Mechanism of Action 

Prevents VEGF-mediated cell proliferation, which inhibits vascular growth 


Adult patients with metastatic colorectal cancer who received previous standard chemotherapy, including fluoropyrimidine, oxaliplatin, and irinotecan 


Available in 1 mg and 5 mg capsules, fruquintinib’s recommended dose is 5 mg once daily for 21 days during each 28-day cycle. Dose reductions or discontinuation are recommended for unacceptable adverse reactions. 

  • First dose reduction: 4 mg orally once daily 
  • Second dose reduction: 3 mg orally once daily 

Refer to the package insert for individualized dose reduction recommendations. 


Take orally once daily with or without food. Swallow the capsule whole with water at the same time each day. Missed doses can be taken within 12 hours; if more than 12 hours have passed, skip the dose and resume at the normal dosage time the next day. Do not take two doses to make up for the missed dose. 

Adverse Reactions 

More than 20% of patients in the clinical trials experienced hypertension, hemorrhage, infection, gastrointestinal perforation, hepatotoxicity, proteinuria, hand-foot syndrome, posterior reversible encephalopathy syndrome, and embryo-fetal toxicity. 

Nursing Considerations 

Complete an oral adherence assessment and assess patients’ ability to safely take the drug. Closely monitor patients’ laboratory values (liver and kidney function, hematology), risks for infection, bowel and bladder function, neurologic status, and skin conditions. 

Patient Education 

Focus on proper administration, oral adherence, and preventing and managing side effects. Educate patients about the common side effects, as well as signs and symptoms of high blood pressure, bleeding, infection, gastrointestinal perforation, liver failure, and kidney dysfunction. Discuss the need for surveillance for hand-foot syndrome and neurologic changes. Advise patients about the risk for embryo-fetal toxicity and instruct them to use effective contraception during treatment and for two weeks after the final dose. 

Special Considerations 

Fruquintinib’s safety has not been tested in patients younger than 18 years. Its safety for patients with moderate liver impairment has not been established. It is not advised for patients with severe liver dysfunction. 

Safe Handling 

Store at room temperature, secured away from children, and dispose of according to local requirements. 

Patient Assistance 

Visit or call 844-817-6468.