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    Value of tumor growth rate (TGR) as an early biomarker predictor of patients' outcome in neuroendocrine tumors (NET)-The GREPONET Study

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    Authors
    Lamarca, Angela
    Crona, J
    Ronot, M
    Opalinska, M
    Lopez, L
    Pezzutti, D
    Najran, Pavan
    Carvhalo, L
    Franca, Bezerra R
    Borg, P
    Vietti, V
    Vidal, T
    de Mestier, L
    Schaefer, N
    Sundin, A
    Costa, F
    Pavel, M
    Dromain, C
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    Affiliation
    Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
    Issue Date
    2019
    
    Metadata
    Show full item record
    Abstract
    INTRODUCTION: Tumor growth rate (TGR; percent size change per month [%/m]) is postulated to be an early radiological biomarker to overcome limitations of RECIST. This study aimed to assess the impact of TGR in neuroendocrine tumors (NETs) and potential clinical and therapeutic applications. MATERIALS AND METHODS: Patients (pts) with advanced grade (G) 1/2 NETs from the pancreas or small bowel initiating systemic treatment (ST) or watch and wait (WW) were eligible. Baseline and follow-up scans were retrospectively reviewed to calculate TGR at pretreatment (TGR0), first follow-up (TGRfirst), and 3(�1) months of study entry (TGR3m). RESULTS: Out of 905 pts screened, 222 were eligible. Best TGRfirst (222 pts) cutoff was 0.8 (area under the curve, 0.74). When applied to TGR3m (103 pts), pts with TGR3m <0.8 (66.9%) versus TGR3m ? 0.8 (33.1%) had longer median progression-free survival (PFS; 26.3 m; 95% confidence interval [CI] 19.5-32.4 vs. 9.3 m; 95% CI, 6.1-22.9) and lower progression rate at 12 months (7.3% vs. 56.8%; p = .001). WW (vs. ST) and TGR3m ? 0.8 (hazard ratio [HR], 3.75; 95% CI, 2.21-6.34; p < .001) were retained as factors associated with a shorter PFS in multivariable Cox regression. TGR3m (HR, 3.62; 95% CI, 1.97-6.64; p < .001) was also an independent factor related to shorter PFS when analysis was limited to pts with stable disease (81 pts). Out of the 60 pts with TGR0 data available, 60% of pts had TGR0 < 4%/month. TGR0 ? 4 %/month (HR, 2.22; 95% CI, 1.15-4.31; p = .018) was also an independent factor related to shorter PFS. CONCLUSION: TGR is an early radiological biomarker able to predict PFS and to identify patients with advanced NETs who may require closer radiological follow-up. IMPLICATIONS FOR PRACTICE: Tumor growth rate at 3 months (TGR3m) is an early radiological biomarker able to predict progression-free survival and to identify patients with advanced neuroendocrine tumors who may require closer radiological follow-up. It is feasible to calculate TGR3m in clinical practice and it could be a useful tool for guiding patient management. This biomarker could also be implemented in future clinical trials to assess response to therapy.
    Citation
    Lamarca A, Crona J, Ronot M, Opalinska M, Lopez Lopez C, Pezzutti D, et al. Value of tumor growth rate (TGR) as an early biomarker predictor of patients' outcome in neuroendocrine tumors (NET)-The GREPONET Study Study. Oncologist. 2019.
    Journal
    Oncologist
    URI
    http://hdl.handle.net/10541/621750
    DOI
    10.1634/theoncologist.2018-0672
    PubMed ID
    30910869
    Additional Links
    https://dx.doi.org/10.1634/theoncologist.2018-0672
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1634/theoncologist.2018-0672
    Scopus Count
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