New research in October 2023 issue JNCCN—Journal of the National Comprehensive Cancer Network In addition to standard systemic therapy, intensive local treatment to remove as much tumor as possible (known as “debulking”) has a significant impact on the overall quality of life of patients with metastatic colorectal cancer. I discovered that it does not give .
Researchers looked at the ongoing ORCHESTRA trial (NCT01792934) and compared patients treated with standard palliative chemotherapy alone versus those treated with surgery, ablative therapy, and/or radiotherapy to reduce tumor burden. In addition, patients who received palliative chemotherapy were compared. Three hundred patients were randomized to receive standard treatment or additional intervention. Serious adverse events were reported in 21% of patients in the standard group and 43% of patients who also underwent cytoreduction. However, there were no statistically or clinically relevant differences in patient-reported outcomes regarding overall health-related quality of life or fatigue.
“This may mean that the negative impact on quality of life from complications is temporary and is eventually balanced out by a reduction in tumor-related symptoms after treatment. It is also possible to adapt the perception of HRQoL during the course of treatment,” explained lead author Lotte Backels, MD, from the Radboud Institute for Health Sciences in the Netherlands. “Given the significant amount of complications associated with topical treatment, we expected to see a greater impact on overall and durable quality of life in the experimental group. The severe side effects associated with topical treatment The fact that this did not lead to a significant decrease in patients’ perceived quality of life is of great interest and warrants further investigation. should be considered in the consulting room to determine the choice together with the patient.”
This study focused on the results of a pre-planned exploratory secondary endpoint of health-related quality of life (HRQoL) in the ORCHESTRA trial, including the EORTC QoL Questionnaire-Core 30 at pre-specified times. and was measured using the Multidimensional Fatigue Inventory questionnaire. Time point during treatment. The intervention arm included first-line FOLFOX or CAPOX +/- bevacizumab plus multisystem debulking to shrink the tumor by at least 80%. This was compared to a control group of palliative systemic chemobiological therapy alone.
“Tumor debulking for patients with synchronous rare metastatic colorectal cancer is often used for curative purposes and is supported by the NCCN Guidelines, and is preferred by surgery over other acceptable treatments such as radiation therapy and thermal ablation. Resection is preferred. However, the potential survival benefit of such interventions has not been established for patients with colorectal cancer metastases in multiple organs rather than in a single organ. “These are questions we are trying to answer,” said Charles J. Schneider, MD, FACP, professor of clinical medicine at the Perelman School of Medicine at the University of Pennsylvania and a gastrointestinal oncologist at Penn Medicine’s Abramson Cancer Center.
Dr. Schneider is a member of the NCCN Oncology Clinical Practice Guidelines (NCCN Guidelines) colorectal/anal cancer panel and was not involved in this study. He continued:
“Our results were surprising, as we found no statistically significant or clinically relevant differences in HRQoL and fatigue at 1 year. More interestingly, patients in the intervention group compared with patients in the standard group. Despite experiencing topical treatment-related serious adverse events (SAEs) twice as often as women, there was a notable lack of association between the occurrence of SAEs and health outcomes. The fact is that HRQoL. This HRQoL “equivalence” therefore means that even if there are twice as many SAEs in the intervention group, if survival data turns out to be in favor of the intervention, then the This should provide a cautious justification for the combination of multisystem tumor debulking and palliative chemotherapy in patients with cancer. Groups too. ”
To read the entire study, please visit JNCCN.org. Free access toHealth-related quality of life in patients with metastatic colorectal cancer receiving systemic therapy with or without maximal tumor debulking‘ is being distributed until January 10, 2024.
This news Originally published on the National Comprehensive Cancer Network website on October 12, 2023.