466P - Mixed Adeno-Neuroendocrine Carcinoma (MANEC) of the gastroenteropancreatic (GEP) tract: a multicentre retrospective study

Date 10 September 2017
Event ESMO 2017 Congress
Session Poster display session
Topics Neuroendocrine Cancers
Endocrine Cancers
Presenter Melissa Frizziero
Citation Annals of Oncology (2017) 28 (suppl_5): v142-v157. 10.1093/annonc/mdx368
Authors M. Frizziero1, X. Wang2, B. Chakrabarty3, A. Childs4, T.V. Luong5, T. Walter6, M. Elshafie7, T. Shah8, P. Fulford9, A. Minicozzi9, W. Mansoor1, T. Meyer10, R.A. Hubner1, J.W. Valle11, M.G. McNamara1
  • 1Department Of Medical Oncology, The Christie NHS Foundation Trust, M206SL - Manchester/GB
  • 2Department Of Analytics And Development, The Christie NHS Foundation Trust, M206SL - Manchester/GB
  • 3Department Of Pathology, The Christie NHS Foundation Trust, M206SL - Manchester/GB
  • 4Medical Oncology, Royal Free London NHS Foundation Trust, NW3 2QG - London/GB
  • 5Department Of Histopathology, Royal Free Hospital, NW3 2QG - London/GB
  • 6Gastroenterology And Medical Oncology, Hospices Civils de Lyon, Lyon1 University, 69437 - Lyon/FR
  • 7Department Of Pathology, University Hospital of Birmingham NHS Foundation Trust, B15 2TH - Birmingham/GB
  • 8Department Of Hepatology, University Hospital of Birmingham NHS Foundation Trust, B15 2TH - Birmingham/GB
  • 9Department Of Surgical Oncology, The Christie NHS Foundation Trust, M206SL - Manchester/GB
  • 10Department Of Medical Oncology, Royal Free London NHS Foundation Trust, NW3 2QG - London/GB
  • 11Medical Oncology, The Christie NHS Foundation Trust, M206SL - Manchester/GB

Abstract

Background

MANEC is a rare entity and evidence on its prognosis and management is limited.

Methods

Demographic/clinicopathological/survival data of consecutive patients (pts) with a diagnosis of MANEC (2010 WHO criteria) from 4 European centres were retrospectively reviewed.

Results

Fifty-three pts were identified (01/06-03/17); median (med) age: 62 yrs (range 34-89), male: 70%, ECOG PS 0-1: 60%, with primary tumours from small/large bowel in 34 (64%), oesophagus/stomach: 13 (24.5%), pancreas/biliary tract: 5 (9.5%), unknown (UNK): 1 (2%). Forty percent had an adult comorbidity evaluation (ACE)-27 score of 0. The neuroendocrine (NE) component (predominant histology in 40%) was poorly-differentiated (PD) in 45 (85%) [Ki-67≥55%: 58%]. Most frequently-expressed immunohistochemical (IHC) markers were synaptophysin (100%), chromogranin A (CgA) (58.5%) and CDX2 (51%). Histology was PD NE in 64% from recurrent/metastatic sites (n = 14 pts). Of 28 (53%) pts with localised disease (LA), 26 (93%) had curative surgery (7 had neoadjuvant chemo-radiotherapy (CT-RT), 6 adjuvant CT, 1 peri-operative CT), 1 (3.5%) had definitive CT-RT and 1 (3.5%) had UNK management; 16 (57%) recurred. Forty-one pts (77%) were treated for advanced (adv) disease: 20 (49%) platinum-based CT, 3 (7%) irinotecan-based CT, 1 (2.4%) gemcitabine, 3 (7%) UNK CT regimen, 1 (2.4%) RT, 1 (2.4%) CT-RT, 11 (27%) best supportive care (BSC), and 1 (2.4%) UNK management. Med follow-up time was 10.4 months (mo) (95% Confidence Interval (CI) 5.15-13.09). Med overall survival (OS) for all pts was 18.6 mo (95% CI 11.4-40). Med recurrence-free survival and OS in pts with LA was 19.4 mo (95%CI 5.8-30.9) and 21 mo (95%CI 12.1-40). Med progression free survival (PFS) and OS in pts with adv disease was 4.6 mo (95%CI 3.3-6.7) and 13.6 mo (95%CI 8.8-33.1). On univariable analysis, ACE-27 score (0 vs ≥ 1) was prognostic for better PFS and OS (both p 

Conclusions

PD NE histology in MANECs was predominant in both diagnostic and recurrent/metastatic tumour samples. Active treatments were offered to most pts but more effective therapy is clearly needed.

Clinical trial identification

Legal entity responsible for the study

The Christie NHS Foundation Trust

Funding

The Christie

Disclosure

All authors have declared no conflicts of interest.