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Poster display session: Basic science, Endocrine tumours, Gastrointestinal tumours - colorectal & non-colorectal, Head and neck cancer (excluding thyroid), Melanoma and other skin tumours, Neuroendocrine tumours, Thyroid cancer, Tumour biology & pathology

4576 - Treatment outcomes for well differentiated grade 3 neuroendocrine tumors (NET G3)

Date

21 Oct 2018

Session

Poster display session: Basic science, Endocrine tumours, Gastrointestinal tumours - colorectal & non-colorectal, Head and neck cancer (excluding thyroid), Melanoma and other skin tumours, Neuroendocrine tumours, Thyroid cancer, Tumour biology & pathology

Presenters

Leonidas Apostolidis

Citation

Annals of Oncology (2018) 29 (suppl_8): viii467-viii478. 10.1093/annonc/mdy293

Authors

L. Apostolidis, D. Jäger, E.C. Winkler

Author affiliations

  • Department Of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, 69120 - Heidelberg/DE
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Resources

Abstract 4576

Background

In the most current WHO classification for tumors of the endocrine organs, well differentiated grade 3 neuroendocrine tumors (NET G3) have been distinguished from poorly differentiated grade 3 neuroendocrine carcinomas (NEC G3). Retrospective data suggest that commonly applied first-line chemotherapy protocols with cisplatin or carboplatin in combination with etoposide (PE) are less effective in NET G3 than NEC G3. Therefore current treatment guidelines suggest alternative first-line treatment with protocols like temozolomide-based (TEM) which have only been evaluated in second-line so far. The aim of this study was to evaluate treatment outcomes for NET G3 with a focus on efficacy of different first-line regimens.

Methods

Retrospective analysis of all patients with NET G3 in the NEN database of our center. All histopathological findings were reviewed by the investigators in order to comply with the most current WHO classification.

Results

A total of 89 patients could be identified. Primary tumors were mainly located in the pancreas. Median overall survival (OS) was not reach during a median follow-up of 18.4 months. 79 patients received palliative first-line therapy: PE 34, FOLFOX 17, TEM 12, other (including streptozotocin-based regimens, targeted agents, peptide receptor radionuclide therapy, somatostatin analogues) 16. Overall response (ORR) and disease control rate (DCR) was 38.2 % and 70.6 % for PE, 64.7 % and 82.4 % for FOLFOX, 12 % and 58.3 % for TEM, 25 % and 62.5 % for other respectively. Median progression-free survial for PE was 6.7 months. Compared to PE, the other treatment groups showed a trend towards a prolonged PFS (FOLFOX 8.6 months, p = 0.151; TEM 10.8 months; p = 0.333, other 12.0 months, p = 0.085). All non-PE patients combined showed a significantly prolonged PFS vs. PE (10.8 months; p = 0.039).

Conclusions

In this first comparative analysis of first-line treatments for NET G3, patients treated with non-PE regimens show a significantly prolonged PFS. Regarding ORR, FOLFOX seems to be the most active therapeutic regimen. Further prospective evaluation of the optimal therapeutic strategy for this newly defined tumor entity is needed.

Clinical trial identification

The trial was approved by the institutional research ethics committee (approval S-428/2014).

Legal entity responsible for the study

National Center for Tumor Diseases (NCT) Heidelberg.

Funding

Has not received any funding.

Editorial Acknowledgement

Disclosure

All authors have declared no conflicts of interest.

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