Study finds that tumor debulking does not affect quality of life in patients with metastatic colorectal cancer

New research in October 2023 issue JNCCN-;National Comprehensive Cancer Network Journal 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.

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. A patient may also adapt her HRQoL perceptions over the course of illness and treatment. Given the significant amount of complications from local treatment, we expected to see a greater impact on overall and sustained quality of life in the experimental group. The fact that the severe side effects associated with topical therapy did not lead to a significant decrease in patients’ perceived quality of life is of great interest and warrants further investigation. These results, including the risk of complications, should be considered in the office to determine together with the patient the appropriate treatment choice for each individual. ”

Lotte Backels, MD, lead author, Radboud Institute for Health Sciences, The Netherlands

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.

“Tuber 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 compared to other acceptable treatments such as radiation therapy or thermal ablation. However, the potential survival benefit has not been established for patients with single-organ rather than multi-organ colorectal cancer metastases. These are the questions the trial seeks to answer,” commented Charles J. Schneider, MD, FACP. He is a gastrointestinal oncologist at the University of Pennsylvania Perelman School of Medicine and the 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. ”