Researchers have found that in patients with multivisceral metastatic colorectal cancer, removing as much tumor as possible using various methods does not reduce quality of life, although it increases adverse events. Survival benefits are still unknown.
Plymouth Meeting, Pennsylvania, October 12, 2023 /PRNewswire/ — New research in October 2023 Problem of 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”) can have a significant impact on the overall quality of life of patients with metastatic colorectal cancer. I discovered that it doesn’t give.
The October 2023 edition of JNCCN is now available at JNCCN.org.
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. There is also the potential to adapt perceptions of HRQoL over the course of illness and treatment,” explained the first author. Lotte Backels, MD, Radboud Institute of Health Sciences; Netherlands. “We expected to see a greater impact on the overall and lasting quality of life in the experimental group, given the significant amount of complications associated with topical treatment. The fact that topical treatment is associated with severe side effects “Perceived quality of life is of great interest and requires further investigation. These results, including the risk of complications, should be considered appropriate for each individual.” should be considered in the office to determine appropriate treatment options 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 with curative intent, is supported by the NCCN Guidelines, and is preferred by surgery over other acceptable treatments such as radiation therapy and thermal ablation. However, the potential survival benefits of such interventions have not been established for patients with colorectal cancer metastases in multiple organs rather than in a single organ. That’s the question I’m trying to answer.” Charles J. SchneiderMD, FACP, Professor of Clinical Medicine University of Pennsylvania Gastrointestinal oncologist at Perelman School of Medicine and University of Pennsylvania 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:
“The finding that we found no statistically significant or clinically relevant differences in HRQoL and fatigue after 1 year was surprising. Even more interesting, patients in the intervention group patients in the standard group experienced a significant lack of association between the occurrence of SAEs and the impact on HRQoL. Therefore, this ‘equivalence’ of her HRQoL should provide a prudent justification even though her SAE in the intervention group was twice hers. Combine multiorgan tumor debulking with palliative chemotherapy in selected patients if survival data proves to favor the intervention group as well. ”
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 debulkingAvailable up to January 10, 2024.
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