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Efficacy and safety of targeted agents for treatment of gastroenteropancreatic (GEP) neuroendocrine tumor (NET)

Date

08 Oct 2016

Session

Poster Display

Presenters

Heejung Chae

Citation

Annals of Oncology (2016) 27 (6): 136-148. 10.1093/annonc/mdw369

Authors

H. Chae1, C. Yoo2, K. Kim2, H. Chang2, T.W. Kim2, Y.S. Hong3, S. Hong4, S.C. Kim5, B. Ryoo2

Author affiliations

  • 1 Internal Medicine, Asan Medical Center, 05505 - Seoul/KR
  • 2 Department Of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 05505 - Seoul/KR
  • 3 Department Of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul/KR
  • 4 Pathology, Asan Medical Center, 05505 - Seoul/KR
  • 5 Department Of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 05505 - Seoul/KR
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Background

Efficacy and safety of targeted agents, such as everolimus and sunitinib, have been demonstrated in the prospective trials for patients with GEP-NET. Considering heterogeneous clinical features of NET, evaluation of real-world outcomes with these agents are necessary. We retrospectively analyze the treatment outcomes of everolimus and sunitinib for patients (pts) with GEP-NET.

Methods

Between Mar 2007 and Oct 2014, a total of 44 GEP-NET pts treated with everolimus or sunitinib were included. Considering distinct characteristics between pancreatic (Pan) and non-PanNETs, efficacy analysis was performed separately, while safety analysis included all pts.

Results

PanNET was most common type (n = 28, 64%) and followed by hindgut NET (n = 11, 25%) and foregut NET (n = 5, 11%). Sunitinib and everolimus were given in 27 (61%) and 17 (39%) pts, respectively. Among 41 pts that pathology review was available, tumor grade (G) was G1/2 in 36 (78%) and G3 in 5 (12%). Cytotoxic chemotherapy and somatostatin analogue were previously given in 16 (36%) and 18(41%) pts, respectively. In pts with PanNET, median progression-free survival (PFS) with everolimus and sunitinib was 16.6 months (95% CI, 8.0-25.1) and 8.0 months (95% CI, 0.0-17.4), and there was no significant difference between two agents (p = 0.51). For non-PanNET pts, median PFS was 14.7 months (95% CI, 2.4-27.0) with everolimus and 1.7 months (95% CI, 0.5-3.0; p = 0.001) with sunitinib; G3 tumor and prior cytotoxic chemotherapy were more common in pts with sunitinib than those with everolimus (30% vs 0%, and 70% vs 50%, respectively).Treatment was discontinued due to the adverse events in 3 pts (14%) with sunitinib and 4 (29%) with everolimus. Most common grade 3-4 toxicities were neutropenia (n = 9, 33%), anemia (5, 19%), diarrhea (3, 11%), and hand-foot syndrome (2, 7%) in pts with sunitinib (n = 27), and pneumonitis (2, 12%), and thrombocytopenia/stomatitis (1, 6%) in those with everolimus (n = 17). Tumor grade was a significant predictive factor for PFS (G1/2: median 14.7 months vs G3: 2.5 months, p = 0.002).

Conclusions

Both everolimus and sunitinib were well tolerable and effective in GEP-NET pts. The activity of everolimus was seen across all GEP-NETs and consistent with previous trials.

Clinical trial identification

Legal entity responsible for the study

Asan Medical Center (AMC) IRB

Funding

None

Disclosure

All authors have declared no conflicts of interest.

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