Treatment outcomes of advanced digestive well-differentiated grade 3 NETs

in Endocrine-Related Cancer
View More View Less
  • 1 L de Mestier, Gastroenterology and Pancreatology, Hopital Beaujon, Clichy, France
  • 2 A Lamarca, Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom of Great Britain and Northern Ireland
  • 3 J Hernando, Medical Oncology, Vall d'Hebron Hospital Universitari, Barcelona, 08035, Spain
  • 4 W Zandee, Internal Medicine, Erasmus MC, Rotterdam, 9713GZ, Netherlands
  • 5 T Alonso-Gordoa, Medical Oncology, Hospital Universitario Ramon y Cajal, Madrid, Spain
  • 6 M Perrier, Digestive Oncology, CHU Reims, Reims, France
  • 7 A Walenkamp, Medical Oncology, University Medical Center Groningen, Groningen, Netherlands
  • 8 B Chakrabarty, Pathology, The Christie NHS Foundation Trust, Manchester, United Kingdom of Great Britain and Northern Ireland
  • 9 S Landolfi, Pathology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
  • 10 M Van Velthuysen, Pathology, Erasmus MC, Rotterdam, Netherlands
  • 11 G Kats-Ugurlu, Pathology, UMCG, Groningen, Netherlands
  • 12 A Carminoa, Pathology, Hospital Universitario Ramon y Cajal, Madrid, Spain
  • 13 M Ronot, Radiology, Beaujon Hospital, Clichy, France
  • 14 P Manoharan, Radiology and Nuclear Medicine, The Christie NHS Foundation Trust, Manchester, United Kingdom of Great Britain and Northern Ireland
  • 15 A Garcia-Alvarez, Medical Oncology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
  • 16 T Brabander, Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
  • 17 M García Gómez-Muriel, Radiology, Hospital Universitario Ramon y Cajal, Madrid, Spain
  • 18 G Cadiot, Gastroenterology and Digestive Oncology, Hopital Robert Debré, Reims, France
  • 19 A Couvelard, Department of Pathology, Beaujon-Bichat University Hospitals, PARIS, 75018, France
  • 20 J Capdevilla, Medical Oncology Department, Hospital Universitario Vall d’Hebron, Autonomous University of Barcelona,, Barcelona, United Kingdom of Great Britain and Northern Ireland
  • 21 M Pavel, Department of Medicine 1, Division of Endocrinology and Diabetology, Friedrich-Alexander Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
  • 22 J Cros, Pathology, Beaujon Hospital - Paris Diderot University - INSERM U1149, Clichy, France

Correspondence: Louis de Mestier, Email: louisdemestier@hotmail.com
Restricted access

There is no standardized treatment for grade 3 neuroendocrine tumors (G3 NETs). We aimed to describe the treatments received in patients with advanced G3 NETs and compare their efficacy. Patients with advanced digestive G3 NETs treated between 2010 and 2018 in seven expert centers were retrospectively studied. Pathological samples were centrally reviewed, and radiological data were locally reviewed. We analyzed RECIST-defined objective response (OR), tumor growth rate (TGR) and progression-free survival (PFS) obtained with first- (L1) or second-line (L2) treatments. We included 74 patients with advanced G3 NETs, mostly from duodenal or pancreatic origin (71.6%), with median Ki-67 of 30%. The 126 treatments (L1=74; L2=52) included alkylating-based (n=32), etoposide-platinum (n=22) or adenocarcinoma-like chemotherapy (n=20), somatostatin analogs (n=21), targeted therapies (n=22) and liver-directed therapies (n=7). Alkylating-based chemotherapy achieved the highest OR rate (37.9%) compared to other treatments (multivariable OR 4.22, 95% CI [1.5-12.2]; p=0.008). Adenocarcinoma-like and alkylating-based chemotherapies showed the highest reductions in 3-month TGR (p<0.001 and p=0.008, respectively). The longest median PFS were obtained with adenocarcinoma-like chemotherapy (16.5 months [9.0-24.0]) and targeted therapies (12.0 months [8.2-15.8]), while the shortest PFS were observed with somatostatin analogues (6.2 months [3.8-8.5]) and etoposide-platinum chemotherapy (7.2 months [5.2-9.1]). Etoposide-platinum CT achieved shorter PFS than adenocarcinoma-like (multivariable HR 3.69 [1.61-8.44], p=0.002) and alkylating-based chemotherapies (multivariable HR 1.95 [1.01-3.78], p=0.049). Overall, adenocarcinoma-like and alkylating-based chemotherapies may be the most effective treatments for patients with advanced G3 NETs regarding OR and PFS. Etoposide-platinum chemotherapy has poor efficacy in this setting.

 

Society for Endocrinology

Sept 2018 onwards Past Year Past 30 Days
Abstract Views 354 354 354
Full Text Views 14 14 14
PDF Downloads 18 18 18