Peptide receptor radionuclide therapy in gastroenteropancreatic NEN G3: a multicenter cohort study
Peptide receptor radionuclide therapy in gastroenteropancreatic NEN G3: a multicenter cohort study
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DOI：
10.1530/erc-18-0424
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发表时间：
2019-02-01
影响因子：
3.9
通讯作者：
Sorbye, Halfdan
中科院分区：
文献类型：
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作者：
Carlsen, Esben Andreas;Fazio, Nicola;Sorbye, Halfdan
肽受体放射性核素疗法 (PRRT) 是 1-2 级转移性神经内分泌肿瘤 (G1-G2) 的既定治疗方法。然而，其对高级别胃肠胰腺 (GEP) 神经内分泌肿瘤 (NEN G3) 的可能益处尚不清楚。因此，我们的目的是评估 PRRT 对 GEP NEN G3 患者的益处和副作用。我们在 12 个中心进行了一项回顾性队列研究，以评估 PRRT 对 GEP NEN G3 患者的疗效和毒性。结果包括缓解率、疾病控制率、无进展生存期（PFS）、总生存期（OS）和毒性。我们纳入了 149 名患者（原发肿瘤：胰腺 n = 89，胃肠道 n = 34，未知 n = 26）。 PRRT 是一线治疗 (n = 30)、二线治疗 (n = 62) 或后期治疗 (n = 57)。在接受评估的 114 名患者中，1% 完全缓解，41% 部分缓解，38% 疾病稳定，20% 疾病进展。在 PRRT 前记录有疾病进展的 104 名患者中，疾病控制率为 69%。总队列的中位 PFS 为 14 个月，OS 为 29 个月。 Ki-67 21-54% (n = 125) 对比 Ki-67 >= 55% (n = 23)：PFS 16 对比 6 个月 (P < 0.001)，OS 31 对比 9 个月 (P < 0.001)。良好 (n = 60) 与低分化 NEN (n = 62) 相比：PFS 19 与 8 个月 (P < 0.001)，OS 44 与 19 个月 (P < 0.001)。 17% 的患者出现 3-4 级血液学或肾毒性。这一大型多中心 GEP NEN G3 患者队列采用 PRRT 治疗，显示出有希望的缓解率、疾病控制率、PFS 和 OS 以及对主要患有进展性疾病的患者的毒性。根据这些结果，GEP NEN G3 患者可考虑进行 PRRT。
Peptide receptor radionuclide therapy (PRRT) is an established treatment of metastatic neuroendocrine tumors grade 1-2 (G1-G2). However, its possible benefit in high-grade gastroenteropancreatic (GEP) neuroendocrine neoplasms (NEN G3) is largely unknown. We therefore aimed to assess the benefits and side effects of PRRT in patients with GEP NEN G3. We performed a retrospective cohort study at 12 centers to assess the efficacy and toxicity of PRRT in patients with GEP NEN G3. Outcomes were response rate, disease control rate, progression-free survival (PFS), overall survival (OS) and toxicity. We included 149 patients (primary tumor: pancreatic n = 89, gastrointestinal n = 34, unknown n = 26). PRRT was first-line (n = 30), second-line (n = 62) or later-line treatment (n = 57). Of 114 patients evaluated, 1% had complete response, 41% partial response, 38% stable disease and 20% progressive disease. Of 104 patients with documented progressive disease before PRRT, disease control rate was 69%. The total cohort had median PFS of 14 months and OS of 29 months. Ki-67 21-54% (n = 125) vs Ki-67 >= 55% (n = 23): PFS 16 vs 6 months (P < 0.001) and OS 31 vs 9 months (P < 0.001). Well (n = 60) vs poorly differentiated NEN (n = 62): PFS 19 vs 8 months (P < 0.001) and OS 44 vs 19 months (P < 0.001). Grade 3-4 hematological or renal toxicity occurred in 17% of patients. This large multicenter cohort of patients with GEP NEN G3 treated with PRRT demonstrates promising response rates, disease control rates, PFS and OS as well as toxicity in patients with mainly progressive disease. Based on these results, PRRT may be considered for patients with GEP NEN G3.