Abstract
Objective. Patients with gastroenteropancreatic neuroendocrine carcinoma (NEC) have a poor prognosis. Platinum-based combination chemotherapy is commonly used as first-line treatment; however, the role of salvage chemotherapy remains unknown. This study aimed to analyze the efficacy and safety of amrubicin monotherapy in patients with platinum-refractory gastroenteropancreatic NEC. Methods. Among 22 patients with advanced gastroenteropancreatic NEC, 10 received amrubicin monotherapy between September 2007 and May 2014 after failure of platinum-based chemotherapy. The efficacy and toxicity of the treatment were analyzed retrospectively. Results. Eight males and two females (median age, 67 years (range, 52–78)) received platinum-based chemotherapy, including cisplatin plus irinotecan (n = 7, 70%), cisplatin plus etoposide (n = 2, 20%), and carboplatin plus etoposide (n = 1, 10%) before amrubicin therapy. Median progression-free survival and overall survival after amrubicin therapy were 2.6 and 5.0 months, respectively. Two patients had partial response (20% response rate), and their PFS were 6.2 months and 6.3 months, respectively. Furthermore, NEC with response for amrubicin had characteristics with a high Ki-67 index and receipt of prior chemotherapy with cisplatin and irinotecan. Grade 3-4 neutropenia and anemia were observed in four and five patients, respectively. Conclusion. Amrubicin monotherapy appears to be potentially active and well-tolerated for platinum-refractory gastroenteropancreatic NEC.
Highlights
Gastroenteropancreatic neuroendocrine neoplasms (NENs) are currently classified into neuroendocrine tumors (NETs) and neuroendocrine carcinoma (NEC) on the basis of the morphology and proliferation rate
21 patients received platinum-based chemotherapy according to the treatment strategy for small cell lung cancer (SCLC) and 10 patients received amrubicin as salvage chemotherapy
Among 11 patients that were not treated with amrubicin, eight patients had not received salvage chemotherapy, and three had received etoposide and carboplatin as second-line chemotherapy, respectively
Summary
Gastroenteropancreatic neuroendocrine neoplasms (NENs) are currently classified into neuroendocrine tumors (NETs) and neuroendocrine carcinoma (NEC) on the basis of the morphology and proliferation rate. According to the 2010 WHO classification, NEC is defined as tumors with poorly differentiated morphology and a high proliferation rate, and it includes small cell type, large cell type, and small and large cell types [1]. Combination chemotherapies of cisplatin plus etoposide or cisplatin plus irinotecan have been widely used for gastroenteropancreatic NEC on the basis of retrospective or small phase II studies [4,5,6]. In a recent retrospective study, 252 patients with advanced gastroenteropancreatic NEC received either cisplatin plus etoposide or carboplatin plus etoposide as a first-line treatment [7]. A Ki-67 index of >55% was Gastroenterology Research and Practice reported to be predictive factors of response for platinumbased chemotherapy
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