1150P - Real-world study on oxaliplatin-based chemotherapy in patients with advanced neuroendocrine neoplasms : clinical outcomes and preliminary correlati...

Date 27 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anti-Cancer Agents & Biologic Therapy
Neuroendocrine Cancers
Presenter Francesca Spada
Citation Annals of Oncology (2014) 25 (suppl_4): iv394-iv405. 10.1093/annonc/mdu345
Authors F. Spada1, N. Fazio1, R. Marconcini2, A. Antonuzzo3, S. Ricci3, A. Fontana4, G. Luppi5, L. Antonuzzo6, F. Di Costanzo7, E. Nobili8, D. Radice9, S. Galdy1, M.A. Sonzogni10, E. Pisa10, M. Barberis10
  • 1Upper Gi And Net Unit, EUROPEAN INSTITUTE OF ONCOLOGY, 20141 - MILAN/IT
  • 2U.o. Oncologia Medica 2 Universitaria, Azienda Ospedaliero Universitaria S.Chiara, 56100 - Pisa/IT
  • 3Oncologia, Trapianti E Nuove Tecnologie In Medicina, Polo Oncologico - Azienda Ospedaliero-Universitaria Pisana - Istituto Toscano Tumori, 56126 - Pisa/IT
  • 4Oncology Unit, University Hospital of Modena and Reggio Emilia, Modena/IT
  • 5Oncology, Haematology And Respiratory Disease, AUO MODENA, 41124 - Modena/IT
  • 6Oncologia Medica, Azienda Ospedaliero-Universitaria Careggi, Firenze/IT
  • 7Oncologia Medica, Azienda Ospedaliera CareggiU.O. Medical Oncology, IT-50139 - Firenze/IT
  • 8Oncologia Medica, Ospedale Sant'Orsola Malpighi, Bologna/IT
  • 9Biostatistics And Epidemiology Department, EUROPEAN INSTITUTE OF ONCOLOGY, 20141 - MILAN/IT
  • 10Pathology, EUROPEAN INSTITUTE OF ONCOLOGY, 20141 - MILAN/IT

Abstract

Aim

Currently there is no standard chemotherapy for well and moderately differentiated neuroendocrine neoplasms (NENs). Some evidences exist for oxaliplatin activity in combination with capecitabine or gemcitabine. We present the results of an Italian multicenter “real-world” study evaluating activity and toxicity of oxaliplatin-based chemotherapy in patients with advanced NENs.

Methods

Clinical records of patients from four centers were reviewed. Response rate (RR), time to progression (TTP), toxicity, and overall survival (OS) were calculated. The tissue tumor samples were centrally analyzed at Istituto Europeo di Oncologia (IEO) to detect Ki67, grade of differentiation and excision repair cross-complementing group-1 (ERCC-1).

Results

Seventy-eight patients were included. The primary neoplasm was: pancreas in 36 (46%), gastrointestinal in 19 (24%), lung in 15 (19%), unknown in 8 (10%). Fifthy-one patients (65%) received capecitabine/oxaliplatin (CAPOX), 5 (6%) gemcitabine/oxaliplatin (GEMOX), 23 (29%) leucovorin/fluorouracil/oxaliplatin (FOLFOX-4). Partial responses (PR) occurred in 20 patients (26%), over half of them pancreatic NENs (PNENs); stable disease (SD) in 42 (55%). With a median follow-up of 21 months the median TTP and OS were respectively 8 and 32 months with 70 and 45 events. A total of 87% of patients experienced adverse events (Grade 3-4 in 20%) most frequently neurological and gastrointestinal. According to 2010 WHO classification, Ki67 labeling index (LI) in the gastro-entero-pancreatic (GEP) NENs was <2% (G1) in 9 (16%), 3-20% (G2) in 36 (65%), >20% (G3) in 9 (16%). As for the Travis' classification, 2/15 (13%) lung NENs were classified as typical carcinoids, 11 (69%) as atypical, one as large cell neuroendocrine carcinoma, and one not otherwise specified. Immunohistochemical (IHC) over-expression for ERCC1 was positive in 4 out of 28 evaluated samples, with no significant correlation with clinical outcome.

Conclusions

This analysis confirms that oxaliplatin-based chemotherapy has a manageable safety profile and is active in advanced NENs independently from the grading of the tumor. The over 80% disease control (PR + SD) and almost one year TTP justify a prospective study in NENs with intermediate biological characteristics, especially with pancreatic primary.

Disclosure

All authors have declared no conflicts of interest.