Standard chemotherapy for extrapulmonary neuroendocrine carcinomas (EPNEC) is not established. Treatment for small cell lung cancer is also used for EPNEC. The efficacy of chemotherapy for elderly patients with EPNEC is not clear. The aim of this study is to estimate the efficacy of chemotherapy in the elderly with EPNEC.
We retrospectively investigated the patients of EPNEC who received 1st line platinum-based chemotherapy between April 2007 to June 2018. The time to treatment failure (TTF), the overall survival time (OST) and the efficacy of chemotherapy were compared between two groups; the elderly patients group in which patients’ age was over 70 years old (group A) and the younger patients group that age under 70 years old (group B).
Among 35 patients with EPNEC, 14 patients were group A and 21 patients were group B. Median age was 75 (70-86) years old in group A, which was 60 (41-69) years old in group B. Primary site included pancreas (n = 3), gastrointestinal (n = 6), prostate (n = 2), and primary unknown (n = 3) in group A, which included pancreas (n = 4), biliary duct (n = 1), gastrointestinal (n = 8), prostate (n = 1), urothelial duct (n = 2), salivary grand (n = 1), and primary unknown (n = 4) in group B. Primary chemotherapy contained cisplatin (CDDP) + etoposide (ETP) (n = 1), carboplatin (CBDCA) + ETP (n = 7), CDDP + irinotecan (CPT-11) (n = 6) in group A, which contained CDDP + ETP (n = 5), CBDCA + ETP (n = 2), CDDP + CPT-11 (n = 14) in group B. The initial dose of chemotherapy reduced in 43% of the patients in group A, which reduced in 23% of that in group B. The Median TTF was 71.5 (25-343) days in group A and 123.0 (41-154) days in group B (p = 0.50) and the median OST was 712 (101-888) days in group A, which was 333 (165-671) days in group B (p = 0.46). One patient (7%) had complete response and 3 patients (21%) had partial response in group A, 0 patient had complete response and 13 patients (61%) had partial response in group B, and disease control rate was 69% in group A, which was 76% in group B.
Though the effect of chemotherapy for the elderly EPNEC patients was insufficient compared with the younger patients, the prognosis was similar to that of the younger. Many of the elderly received CBDCA + ETP and CDDP + CPT-11 regimen, these may be acceptable for the elderly EPNEC.
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All authors have declared no conflicts of interest.