Abstract 3671: First-line treatment of patients with disseminated poorly differentiated neuroendocrine carcinomas with carboplatin, etoposide, and vincristine

Abstract

Abstract Background: The poorly differentiated neuroendocrine carcinomas (PDEC) represent a highly malignant tumor with an immense tendency to metastasize and a poor prognosis, with a median survival of approximately 6 months without treatment. Treatment based on platin and etoposide is widely recommended as palliative chemotherapy and corresponds to the treatment of extensive stage small cell lung cancer. The recommendation is based on relatively few, older studies, which did not use the 2000 WHO tumor classification, and no controlled, randomised studies have been published. Method: Successive chemonaïve patients with disseminated PDEC (small cell carcinomas excluded) allocated for treatment from May 2007 to June 2008 were identified. Patients received carboplatin AUC 5 IV day 1 + etoposide 100 mg/m2 PO day 1-3, and vincristine 1.3 mg/m2 (maximum 2.0 mg) IV day 1. Treatment was repeated every 3 weeks until progression or intolerable toxicity up to a maximum of 6 courses. Results: Twenty-two patients diagnosed with PDEC according to the 2000 WHO tumor classification were eligible for analysis, 11 females and 11 males. The median age was 61 years (range 35-80). Performance status: 0/1/2 = 9/11/2. All patients had disseminated disease. Immunohistochemical analyses of synaptophysin were positive in 21/22 (95.4%), and chromogranin A positive in 17/21 (80.9%). In one patient (4.5%) both analyses were negative; in 17/21 (80.9%) both were positive. The Ki-67 proliferation index ranged from 20% to 100%; the index reaching 50% or higher in 17 patients (77.2%). Octreotide scintigraphy was negative in 10 of 12 scanned patients (83,3%). Three patients (13.6%) achieved complete response (CR), 11 (50%) partial response (PR), 4 (18.2%) no change (NC), and 4 (18.2%) progressive disease (PD). The overall response rate (CR+PR) was 63.6%, and the disease control rate (CR+PR+NC) 81.8%. The median progression free survival time was 7.4 months. The median overall survival time was 10.5 months, and the 1-year survival 48%. Conclusion: In conclusion, treatment with carboplatin, etoposide, and vincristin in previously untreated patients with disseminated PDEC results in a noticeable survival benefit compared to untreated historical controls. The prognosis is however still poor. Note: This abstract was not presented at the AACR 101st Annual Meeting 2010 because the presenter was unable to attend. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 3671.