Understanding the Treatment Algorithm of Patients with Metastatic Pancreatic Neuroendocrine Neoplasms: A Single-Institution Retrospective Analysis Comparing Outcomes of Chemotherapy, Molecular Targeted Therapy, and Peptide Receptor Radionuclide Therapy in 255 Patients
| Autor: | Alexander Crawford, Jennifer Watkins, C Thirlwell, Dalvinder Mandair, Ingrid Y.F. Mak, Martyn Caplin, Tim Meyer, Aimee R. Hayes, Shaunak Navalkissoor, Bernard Khoo, Christos Toumpanakis, Rishi D. Naik, Tu Vinh Luong, Nicholas Evans, Ashley Grossman |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Oncology medicine.medical_specialty Adolescent Endocrinology Diabetes and Metabolism medicine.medical_treatment Antineoplastic Agents Systemic therapy Targeted therapy Young Adult Cellular and Molecular Neuroscience Endocrinology Internal medicine Outcome Assessment Health Care medicine Humans Molecular Targeted Therapy Prospective cohort study Aged Retrospective Studies Aged 80 and over Chemotherapy Radiotherapy Endocrine and Autonomic Systems Proportional hazards model business.industry Retrospective cohort study Middle Aged Pancreatic Neoplasms Neuroendocrine Tumors Radionuclide therapy Cohort Female business Algorithms |
| Zdroj: | Neuroendocrinology. 111:863-875 |
| ISSN: | 1423-0194 0028-3835 |
| DOI: | 10.1159/000511662 |
| Popis: | Background: The number of therapeutic options for patients with pancreatic neuroendocrine neoplasms (PNEN) has increased, but the optimal therapeutic algorithm has not been defined due to lack of randomised trials comparing different modalities. Methods: We performed a retrospective study in patients with metastatic PNEN treated with ≥1 line of systemic therapy. The relationship between baseline characteristics, treatment type, and time to treatment failure (TTF), time to progression (TTP), and overall survival (OS) was analysed using the Kaplan-Meier method. Univariate and multivariate analyses were performed using the Cox proportional hazards model. Results: Two hundred and fifty-five patients with metastatic PNEN had 491 evaluable lines of therapy. Independent predictors of TTF included treatment type, Ki-67, tumour grade, and chromogranin A. To reduce selection bias, a subgroup of 114 patients with grade 2 (G2) metastatic pancreatic neuroendocrine tumours (PNET) was analysed separately. These patients had received 234 lines of treatment (105 chemotherapy, 82 molecular targeted therapy, and 47 peptide receptor radionuclide therapy [PRRT]). In the G2 cohort, TTF and TTP were superior for PRRT compared with both chemotherapy and molecular targeted therapy. OS in the G2 cohort was also superior for those that had received PRRT compared with those that had not (median 84 vs. 56 months; HR 0.55, 95% CI: 0.31–0.98, p = 0.04). Conclusions: This study suggests that PRRT is associated with superior clinical outcomes relative to other systemic therapies for G2 metastatic PNET. Prospective studies are required to confirm these observations. |
| Databáze: | OpenAIRE |
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