Abstract
PurposeMetastatic neuroendocrine tumors (mNETs) are rare, heterogeneous tumors that present diagnostic and treatment challenges, with limited data on the management of mNETs in clinical practice. The present study was designed to identify current diagnostic and treatment patterns in mNET patients treated in the US community oncology setting.MethodsPatient-level data was collected from medical records of adults with mNETs from the Vector Oncology Data Warehouse, a comprehensive US community oncology network database.ResultsOf the 263 patients included (median follow-up, 22 months; range, 0.1–193.9), 30.4% (80/263) had intestinal tumors, 11.0% (29/263) had pancreatic, and 58.6% (154/263) had tumors of other or unknown location. Progression-free survival (PFS) from the start of first-line therapy differed significantly by tumor grade (log rank P = 0.0016) and location (P = 0.0044), as did overall survival (OS) (grade, P < 0.0001; location, P = 0.0068). Median PFS and OS for patients with undocumented tumor grade were shorter than for patients with G1/G2 tumors and longer than patients with G3 tumors. Median PFS and OS for patients with other or unknown tumors were shorter than for patients with intestinal tumors.ConclusionsWhile potentially confounded by the high number of patients with other or unknown tumor locations, this retrospective study of patients in a US community oncology setting identified the importance of awareness of tumor grade and tumor location at diagnosis, as these were direct correlates of PFS and OS.
Highlights
Systemic treatment options for neuroendocrine tumors (NETs) have increased in specificity and efficacy, including interferon alpha, antiangiogenic drugs, mTOR inhibitors, multikinase inhibitors, and peptide receptor radiotherapy [1,2,3]
We describe the diagnostic and treatment patterns from a group of patients with metastatic NETs (mNETs) who were treated in a US community oncology setting, to better understand the overall management paradigm for patients with mNETs
We examine information from The Vector Oncology Data Warehouse (VODW), a comprehensive cancer patient database that includes electronic medical record and billing system data for patients who were treated in a US community oncology setting
Summary
Systemic treatment options for neuroendocrine tumors (NETs) have increased in specificity and efficacy, including interferon alpha, antiangiogenic drugs, mTOR inhibitors, multikinase inhibitors, and peptide receptor radiotherapy [1,2,3]. Recent randomized, controlled clinical trials have led to an increased number of antiproliferative treatments, including somatostatin analogs (SSAs) and targeted treatments for some patients with advanced, well-differentiated metastatic NETs (mNETs) [4,5,6,7,8]. Differentiated mNETs, which often do not express somatostatin receptors (SSTRs) [10, 11], are generally treated with platinum-based chemotherapy irrespective of primary tumor site [12], while treatment for well-differentiated mNETs is increasingly site specific with antiproliferative therapies, including SSAs for gastroenteropancreatic mNETs [4, 5, 7] and targeted treatment options such as everolimus for pancreatic, gastrointestinal, and lung mNETs and sunitinib for pancreatic mNETs [6, 8, 13,14,15]. Because the majority of well-differentiated NETs express a high density of SSTRs, SSTR subtype 2 [10, 11, 16], imaging with SSTR positron emission
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