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Poster Display session 2

5234 - The ORCHESTRA trial; A phase III trial of adding tumor debulking to systemic therapy versus systemic therapy alone in multi-organ metastatic colorectal cancer (mCRC).


29 Sep 2019


Poster Display session 2


Tumour Site

Colon and Rectal Cancer


Lotte Bakkerus


Annals of Oncology (2019) 30 (suppl_5): v198-v252. 10.1093/annonc/mdz246


L. Bakkerus1, E.C. Gootjes1, E.P. van der Stok2, T.E. Buffart3, B.M. Zonderhuis4, J.B. Tuynman4, M.R. Meijerink5, P.M. van de Ven6, C.J. Haasbeek7, A.J. Ten Tije8, J.W. de Groot9, S.A. Radema10, M.P. Hendriks11, H.H. Helgason12, E. van Meerten13, J.J. Nuyttens14, D.J. Grünhagen2, C. Verhoef2, H.M.W. Verheul10

Author affiliations

  • 1 Location Vumc, Department Of Medical Oncology, Amsterdam University Medical Centers, 1081 HV - Amsterdam/NL
  • 2 Department Of Surgery, Erasmus MC Cancer Institute, Rotterdam/NL
  • 3 Gastrointestinal Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, 1066 CXV - Amsterdam/NL
  • 4 Location Vumc, Department Of Surgery, Amsterdam University Medical Centers, 1081 HV - Amsterdam/NL
  • 5 Location Vumc, Department Of Radiology And Nuclear Medicine, Amsterdam University Medical Centers, 1081 HV - Amsterdam/NL
  • 6 Location Vumc, Institute For Health And Care Research, Department Of Epidemiology And Biostatistics, Amsterdam University Medical Centers, 1081 HV - Amsterdam/NL
  • 7 Location Vumc, Department Of Radiotherapy, Amsterdam University Medical Centers, 1081 HV - Amsterdam/NL
  • 8 Department Of Medical Oncology, Amphia Hospital, 4818 CK - Breda/NL
  • 9 Medical Oncology, Oncology Centre Isala, Zwolle/NL
  • 10 Medical Oncology, Radboud University Medical Center, 6525 GA - Nijmegen/NL
  • 11 Medical Oncology, Northwest Clinics Alkmaar, 1800 AM - Alkmaar/NL
  • 12 Medical Oncology, Haaglanden Medical Center, 2501 CK - The Hague/NL
  • 13 Department Of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam/NL
  • 14 Department Of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam/NL


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Abstract 5234


For selected patients with oligometastatic colorectal cancer (mCRC), local treatment of metastases is standard of care based on retrospective reports showing long term survival rates. Local treatment of metastases is technically feasible in an increasing number of patients with multi-organ mCRC. It is unknown whether patients with extensive disease will benefit from tumor debulking when added to first line palliative chemotherapy.

The aim of the ORCHESTRA trial (NCT01792934) is to improve overall survival (OS) with at least six months by maximal tumor debulking in combination with systemic therapy in patients with multi-organ mCRC.

Trial design

Patients with multi-organ mCRC are eligible if ≥ 80% tumor debulking is deemed feasible by resection, radiotherapy and/or thermal ablative therapy. All patients receive 5FU and oxaliplatin based chemotherapy ± bevacizumab. In case of response or stable disease at first evaluation (+/- 2 months), patients are randomized to continuation of chemotherapy or maximal tumor debulking followed by continuation of chemotherapy. A total of 478 patients will be included to meet the primary endpoint (≥ 6 months OS benefit, power 80%, 5% type I error rate two sided). We define local treatments feasible when they can be performed within a 3-month time period to prevent extensive delay of systemic therapy. Quality of life is an important secondary endpoint of the trial. Tissue and blood specimen are collected for translational research. Currently, 290 patients are included in 27 participating Dutch hospitals. Several centers in the United Kingdom will soon participate in the trial.

Clinical trial identification


Editorial acknowledgement

Legal entity responsible for the study

Amsterdam University Medical Center, Location VUmc.


The ORCHESTRA trial is financially supported by KWF (Dutch Cancer Foundation), Blokker-Verwer foundation and Roche.


All authors have declared no conflicts of interest.

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