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Спутники
РН
SpaceX
Роскосмос
NASA
СпутникиРНSpaceXРоскосмосNASATo the Editor The ORCHESTRA trial addressed the evolving role of local therapy in metastatic colorectal cancer (mCRC). The authors should be commended for their rigorous evaluation of debulking in this challenging setting. The study required that patients have metastases in at least 2 different organs. However, patients had metastatic sites with very different prognoses (eg, lungs, bone, peritoneum). In such widely disseminated disease, progression of the less favorable site inevitably determines survival. We are concerned that the induction systemic therapy was brief—only 3 to 4 cycles—using only capecitabine and oxaliplatin with or without bevacizumab or folinic acid, fluorouracil, and oxaliplatin with or without bevacizumab. Given advanced metastatic disease, these regimens appear insufficient to reliably ensure good control of the systemic disease. Compounding this issue, patients who achieved merely stable disease (vs an objective response) were included. To select candidates who might genuinely benefit from local therapies, a longer induction period leading to a sustained objective response to chemotherapy for a period of at least 3 months is essential.