TOPLINE:
Maximal palliative tumor debulking does not significantly affect overall quality of life among patients with metastatic colorectal cancer.
METHODOLOGY:
The ORCHESTRA trial explored whether adding tumor debulking to standard systemic therapy improves survival in metastatic colorectal cancer. With overall survival results pending, the researchers wanted to know if potential survival advantages would be offset by losses in quality of life.
ORCHESTRA investigators ran an interim analysis to address the quality-of-life question in 300 participants who demonstrated a clinical benefit after three to four cycles of first-line fluoropyrimidines and oxaliplatin with or without bevacizumab.
The team randomly assigned 148 patients to surgery to reduce tumor burden by at least 80% followed by systemic therapy and 152 other patients to systemic therapy alone.
Patients completed the EORTC Quality of Life Questionnaire-Core 30 and the Multidimensional Fatigue Inventory questionnaire at baseline and prespecified time points for 1 year. The EORTC questionnaire assesses physical, social, role, cognitive, and emotional functioning, plus fatigue, pain, nausea/vomiting, dyspnea, insomnia, appetite loss, constipation, and diarrhea.
TAKEAWAY:
Overall, 43% of patients in the surgery arm had serious adverse events vs 21% of patients who received stand-alone systemic therapy (P ≤ .001).
However, the investigators observed no statistically significant or clinically relevant differences in overall health-related quality of life or fatigue between the two groups at any time point.
Healthcare related quality-of-life at 1 year was also not significantly different from baseline in either group.
IN PRACTICE:
“The fact that local therapy associated serious side effects did not translate to a noticeable dip in the patients’ perceived quality of life is quite intriguing” and “could mean that the negative impact of complications on quality of life is temporary and eventually balances out with a decrease in tumor-related symptoms after treatment,” lead author Lotte Bakkerus, MD, Radboud Institute for Health Sciences, the Netherlands, said in a press release.
The results “should give guarded justification for multi-organ tumor debulking combined with palliative chemotherapy in select patients, if the survival data turns out to favor the intervention group as well,” said Charles J. Schneider, MD, of Penn Medicine’s Abramson Cancer Center, Philadelphia, said in the press release.
SOURCE:
The work, led by Lotte Bakkerus, MD, of the Radboud Institute for Health Sciences, the Netherlands, was published in the October 2023 issue of the Journal of the National Comprehensive Cancer Network.
LIMITATIONS:
The overall survival data are pending.
DISCLOSURES:
The work was funded by Roche Nederland and others. The investigators didn’t report any disclosures.
M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who worked for several major news outlets before joining Medscape. Alex is also an MIT Knight Science Journalism fellow. Email: [email protected].
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