Advanced small-bowel well-differentiated neuroendocrine tumours: An international survey of practice on 3(rd)-line treatment
AffiliationDepartment of Medical Oncology, European Neuroendocrine Tumor Society Centre of Excellence, The Christie NHS Foundation Trust, University of Manchester, Manchester M20 4BX
MetadataShow full item record
AbstractBackground: Somatostatin analogues are an established first-line therapy for well differentiated small bowel neuroendocrine tumours (Wd-SBNETs), while and peptide receptor radionuclide therapy (PRRT) is frequently used as a second-line therapy. Adequate treatment selection of third-line treatment remains challenging due to the limited prospective data currently available on the best therapeutic sequence. Aim: To understand current practice and rationale for decision-making by physicians in the 3rd-line setting by building an online survey. Methods: Weighted average (WA) of likelihood of usage between responders (1 very unlikely; 4 very likely) was used to reflect the relevance of factors explored. Results: Replies from representatives of 28 centers were received (5/8/2020-21/9/2020); medical oncologist (53.6%), gastroenterologist (17.9%); United Kingdom (21.4%), Spain (17.9%), Italy (14.3%). Majority from European Neuroendocrine Tumor Society (ENETS) Centres of Excellence (57.1%), who followed ENETS guidelines (82.1%). Generally speaking, 3rd-line treatment for Wd-SBNETs was: everolimus (EVE) (66.7%), PRRT (18.5%), liver embolization (LE) (7.4%) and interferon-alpha (IFN) (3.7%); chemotherapy (0%); decision was based on clinical trial data (59.3%), or personal experience (22.2%). EVE was most likely used if Ki-67 < 10% (WA 3.27/4) or age < 70 years (WA 3.23/4), in the 3rd-line setting (WA 3.23/4); regardless of presence/absence of carcinoid syndrome (CS), rate of progression or extent of disease. Chemotherapy was mainly utilised only if rapid progression (within 6 mo) (WA 3.35/4), Ki-67 10%-20% (WA 2.77/4), negative somatostatin receptor imaging (WA 2.65/4) or high tumour burden (WA 2.77/4); temozolomide or streptozocin was used with capecitabine or 5-fluorouracil (5-FU) (57.7%), FOLFOX (5-FU combined with oxaliplatin) (23.1%). LE was selected if presence of CS (WA 3.24/4) or Ki-67 < 10% (WA 2.8/4), after progression to other treatments (WA 2.8/4). IFN was rarely used (WA 1.3/4). Conclusion: Everolimus was the most frequently used therapeutic option in the third-line setting. The most important factors for decision-making included Ki-67, rate of progression, functionality and tumour burden; since this decision is based on multiple factors, it highlights the need for a multidisciplinary assessment.
CitationLamarca A, Cives M, de Mestier L, Crona J, Spada F, Oberg K, et al. Advanced small-bowel well-differentiated neuroendocrine tumours: An international survey of practice on 3(rd)-line treatment. World J Gastroenterol. 2021;27(10):976-89.
JournalWorld Journal of Gastroenterology
- Treatment of advanced neuroendocrine tumours using combination chemotherapy with lomustine and 5-fluorouracil.
- Authors: Kaltsas GA, Mukherjee JJ, Isidori A, Kola B, Plowman PN, Monson JP, Grossman AB, Besser GM
- Issue date: 2002 Aug
- Systemic treatment of neuroendocrine tumors with hepatic metastases.
- Authors: Demirkan BH, Eriksson B
- Issue date: 2012
- Peptide receptor radionuclide therapy (PRRT) in European Neuroendocrine Tumour Society (ENETS) grade 3 (G3) neuroendocrine neoplasia (NEN) - a single-institution retrospective analysis.
- Authors: Thang SP, Lung MS, Kong G, Hofman MS, Callahan J, Michael M, Hicks RJ
- Issue date: 2018 Feb
- Peptide Receptor Radionuclide Therapy for Advanced Gastroenteropancreatic Neuroendocrine Tumors - from oncology perspective.
- Authors: Kolasińska-Ćwikła A, Łowczak A, Maciejkiewicz KM, Ćwikła JB
- Issue date: 2018
- [Pharmacologic therapy for neuroendocrine tumours].
- Authors: Petrányi A, Bodoky G
- Issue date: 2011 Mar 6