Abstract
BackgroundThere are several treatment modalities for unresectable neuroendocrine tumors. Traditionally, the aim of these treatments has been to reduce the tumor load; referred to as objective response (OR). Less emphasis has been put on inducing the tumors to stop growing without a reduction in total tumor load; termed as stable disease (SD). We wanted to investigate whether achieving OR compared to obtaining SD predicted a longer time to progression (TTP) in patients with neuroendocrine tumors (WHO Grade 1 and 2) treated with peptide receptor radionuclide therapy, chemotherapy or molecular targeted therapy.MethodsPatients treated with either peptide receptor radionuclide therapy (PRRT) with 177Lutetium-DOTA-octreotate, the chemotherapy combination streptozotocin/5-fluorouracil or everolimus were retrospectively assessed to evaluate the effect of the treatments on disease progression. We analyzed the TTP for patients for each treatment modality and compared the TTP between those who achieved OR and those who achieved SD.ResultsAltogether 56 patients treated with PRRT, 32 treated with streptozotocin/5-fluorouracil and 52 treated with everolimus were included in the analyses. The median TTP for those treated with PRRT and achieving OR was 31 months, the TTP for those achieving SD was 43 months (p = 0,2). For patients treated with streptozotocin/5-fluorouracil the results were: OR: 18 months, SD: 23 months (p = 0,9) and for those treated with everolimus; OR: 9 months, SD: 20 months (p = 0,5), respectively. We found no differences between patients achieving OR compared to SD regarding age, sex, stage, primary tumor location, Ki-67% or ongoing treatment with somatostatin analogues.ConclusionsWe found no treatment benefit with regard to TTP for our patients that experienced OR compared to those who achieved SD.
Highlights
There are several treatment modalities for unresectable neuroendocrine tumors
We identified all patients treated with peptide receptor radionuclide therapy (PRRT), the chemotherapy combination streptozocin/5-fluorouracil or everolimus and the radiological response was retrospectively evaluated
Pancreas as the primary tumor location dominated in the group treated with stz/5-FU, comprising 67% of the patients
Summary
There are several treatment modalities for unresectable neuroendocrine tumors. Traditionally, the aim of these treatments has been to reduce the tumor load; referred to as objective response (OR). We wanted to investigate whether achieving OR compared to obtaining SD predicted a longer time to progression (TTP) in patients with neuroendocrine tumors (WHO Grade 1 and 2) treated with peptide receptor radionuclide therapy, chemotherapy or molecular targeted therapy. Neuroendocrine tumors (NET) are a heterogeneous group of tumors arising from neuroendocrine cells. There are several treatment modalities that have been shown to reduce the tumor load or stop tumor growth. Studies reporting the effect of these treatments have put most emphasis on the tumor load reducing effect (objective response; OR). We have had the impression that NET patients who have an objective response often seem to have a shorter time to progression than those who achieve disease stabilization. We wanted to investigate whether there was a difference in the time to progression (TTP) for patients with noncurable neuroendocrine tumors that experience an OR compared to those with SD
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