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Published on: August 14, 2012
Systemic Therapy of Neuroendocrine Neoplasia: Single Center Experience from a Cohort of 110 Consecutive Cases
Karin Mayer1, Selina Kiry1, Anna Yordanova2
1Department of Internal Medicine 3, Center of Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, University Hospital of Bonn, Bonn, Germany.
Objective:
Neuroendocrine neoplasias (NENs) represent a rare and biologically heterogeneous group of malignancies. Treatment of NEN patients remains challenging due to lack of prospective evidence on the choice of ideal therapeutic sequence and therapeutic efficacy in specific individual scenarios.
Methods:
Clinical data on 110 consecutive patients suffering from NEN treated at a single German university center were analyzed, therapeutic regimens applied were assessed, and the outcome was evaluated.
Results:
Histological grading, Ki67 proliferation index, functional activity, and presence of metastases were identified as prognostic markers. 10-year overall survival rates were 92%, 44%, and 0% for G1, G2, and G3 tumors, and 60%, 39%, 69%, 53%, and 0% for Ki67 <2%, 3-5%, 6-20%, 21-49%, and >50%, respectively. Peptide receptor radionuclide therapy (PRRT) and cytostatic chemotherapy were the second most common options, with PRRT being used more frequently in NET G1 and G2 and chemotherapy in NEC G3. Combination chemotherapy with etoposide plus cisplatin or carboplatin showed disease control rates (DCRs) of overall 74%, with a short median progression-free survival (PFS) of 7 or 5 months, respectively. DCR and PFS for PRRT were 89% and 22 months when administered as monotherapy, versus 100% and 27 months upon combination with somatostatin analog (SSA) therapy. Of note, PRRT also achieved disease control as best response in 5/5 (100%) selected cases of NEC G3.
Conclusion:
Further prospective studies are warranted to help stratify available options for therapeutic intervention in NEN patients.
Insights
Treatment for neuroendocrine neoplasias (NENs) is challenging. Peptide receptor radionuclide therapy (PRRT) showed promising results, especially when combined with somatostatin analogs, even in advanced G3 tumors.
Area of Science:
- Oncology
- Nuclear Medicine
Background:
- Neuroendocrine neoplasms (NENs) are rare, heterogeneous malignancies with challenging treatment sequencing.
- Lack of prospective evidence complicates therapeutic decisions for NEN patients.
Purpose of the Study:
- To analyze treatment regimens and outcomes in NEN patients.
- To identify prognostic markers and evaluate the efficacy of different therapies.
Main Methods:
- Retrospective analysis of clinical data from 110 NEN patients treated at a German university center.
- Assessment of therapeutic regimens, including Peptide Receptor Radionuclide Therapy (PRRT) and chemotherapy.
- Evaluation of patient outcomes, survival rates, disease control rates (DCRs), and progression-free survival (PFS).
Main Results:
- Histological grade, Ki67 index, functional activity, and metastases are prognostic markers.
- 10-year survival rates vary significantly by grade (G1: 92%, G2: 44%, G3: 0%) and Ki67 index.
- PRRT demonstrated high DCR (89% monotherapy, 100% with SSA) and long PFS (22 months monotherapy, 27 months with SSA), with notable efficacy in NEC G3.
- Combination chemotherapy showed 74% DCR but shorter PFS.
Conclusions:
- Further prospective studies are needed to optimize therapeutic strategies for NEN patients.
- PRRT shows significant potential, particularly in combination regimens and for advanced disease.
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