1159MO - Survival and prognostic factors analysis of 535 grade 3 gastroenteropancreatic neuroendocrine neoplasm (GEP-NEN): Data from the Spanish Taskforce of Neuroendocrine Tumours Registry (R-GETNE)

Background

G3 NEC represent the most aggressive spectrum of NENs and have limited treatment options. The aim of this study was to analyze the prognostic factors in a large cohort of G3 GEP-NEC from the Spanish Registry.

Methods

R-GETNE includes 4807 GEP-NENs diagnosed between 2004 and 2019. The study cohort included patients with poorly differentiated neuroendocrine carcinomas (NEC) with a Ki67 index >20%.

Results

Of 535 patients with G3 NEC, 29% were ≥70 years (median age 64), 40% women and 85% had ECOG 0-1. The most common primary sites were colorectum (30%), pancreas (24%), unknown (16%), stomach (13%), and small intestine (4%). Stage at diagnosis was I in 3%, II in 9%, III in 20% and IV in 68%. 87% of stage I-III NECs were resected and, of these, 54% received adjuvant chemotherapy. Platin and etoposide was administered to 73% of patients with advanced NECs with a response rate of 64% and a median progression-free survival of 6.1 months. With a median follow-up of 4 years, 353 patients (67%) had died and the median overall survival (OS) was 14 months. Median OS by stage was: stage I, 6.1 years (1.8-NA); II, 5.8 years (1.9-NA); III, 2.1 years (1.5-6.7); and IV, 9.7 months (6.7-12.9). In stage IV, OS by site was: small intestine, 14.0 (12.6-15.8); pancreas, 10.1 (9.5-11.8); rectum, 9.9 (8.2-11.2); stomach, 7.3 (5.2-9.3); colon, 4.7 (2.8-7.0) and unknown primary, 2.7 months (1.9-3.8). Multivariate analysis showed that stage (I-III vs IV, HR 0.43, 0.27–0.81); primary site (small intestine, pancreas and rectum vs others, HR 0.63, 0.44–0.92); ECOG (0-1 vs 2, HR 0.64, 0.37-0.77), and gender (women vs men, HR 0.89, 0.74-0.95) were independent prognostic factors for OS (p<0.05).

Conclusions

This is to date one of the largest reported series of G3 GEP-NECs and provides relevant information to help stratify prognosis of patients for clinical decisions.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

GETNE (Spanish Taskforce of Neuroendocrine Tumours).

Funding

Ipsen.

Disclosure

J. Capdevila: Speaker Bureau/Expert testimony: Novartis, Pfizer, Ipsen, Exelixis, Bayer, Eisai, Advanced Accelerator Applications, Amgen, Sanofi and Merck Serono; Research grant/Funding (self): Novartis, Ipsen, Pfizer, AstraZeneca, Advanced Accelerator Applications and Eisai; Research grant/Funding (institution), Investigator initiated studies supported: Eisai, AstraZeneca and Advanced Accelerator Applications. M. Benavent: Speaker Bureau/Expert testimony: Pfizer, Ipsen, Novartis. V. Alonso-Orduna: Advisory/Consultancy: Amgen, Roche, Servier, Bayer, Ipsen, Novartis; Speaker Bureau/Expert testimony: Merck, Sanofi. T. Alonso: Advisory/Consultancy: Roche, Astellas, Bayer, Ipsen, Pfizer, Sanofi, Janssen-Cilag, MSD, BMS, Eisai; Speaker Bureau/Expert testimony: Ipsen, Pfizer, BMS, Eisai; Leadership role, Clinical Trials: Roche, AstraZeneca, GSK-Novartis, Clovis, Astellas, Bayer, Ipsen, Pfizer, Janssen-Cilag, MSD, BMS, Eisai. M. Sanchez Canovas: Travel/Accommodation/Expenses: Sanofi, MSD, Esteve, Amgen, Servier, Angelini, Leo Pharma; Research grant/Funding (self): LeoPharma; Speaker Bureau/Expert testimony: KyowaKirin. M. Llanos: Advisory/Consultancy: Amgen; Speaker Bureau/Expert testimony: Merck, Roche, Eisai, Servier, Ipsen, Lilly, Bristol, Sanofi, Pfizer. G. Crespo: Advisory/Consultancy: Bristol-Myers Squibb, Ipsen, Roche, Eisai, Sanofi, Eusa Pharma; Speaker Bureau/Expert testimony: Bristol-Myers Squibb, Ipsen, Roche, Eisai, Sanofi, Janssen, Eusa Pharma. A. Teule: Advisory/Consultancy: Novartis Ipsen AAA Pfizer AstraZeneca; Speaker Bureau/Expert testimony: Novartis Ipsen AAA Pfizer AstraZeneca. J. Gallego Plazas: Speaker Bureau/Expert testimony: Lilly, Amgen; Advisory/Consultancy: BMS, Ipsen, Roche, Servier, Merck; Travel/Accommodation/Expenses: Novartis, Amgen. C. López: Advisory/Consultancy: Ipsen, Novartis, Pfizer, AAA, Roche; Speaker Bureau/Expert testimony: Ipsen, Novartis, Pfizer, AAA, Roche; Research grant/Funding (self): Ipsen, AstraZeneca, BMS. All other authors have declared no conflicts of interest.