Advances in the treatment of gastroenteropancreatic neuroendocrine tumors

Figures & data

Table 1 Randomized clinical trials of chemotherapy in GEP-NETs

Regimen	Study design	Tumor type	n	RR (%)	TTP (mo)	OS (mo)	Reference
Strep/5FU vs Strep/Cytoxan	Phase III	Mixed carcinoid and pancreas	42	33	–	–	Moertel^Citation46
			47	26
Strep/5FU vs Doxorubicin	Phase III	Carcinoid only	104	23*	7.8	16	Engstrom^Citation47
			91	20	6.5	12
Strep/Dox vs Strep/5FU vs Chlorotozocin	Phase III	Pancreas only	36	69*	69*	26.4*	Moertel^Citation14
			33	45	45	16.8
			33	30	30	16.8
Strep/5FU vs Dox/5FU	Phase III	Mixed carcinoid and pancreas	88	16	5.3	24.3*	Sun^Citation48
			88	15.9	4.5	15.7

* P ≤ 0.05.

Abbreviations: Dox, doxorubicin; 5FU, 5-fluorouracil; n, number; OS, overall survival; RR, response rate; strep, streptozocin; TTP, time to progression.

Table 2 Selected clinical trials using targeted agents in GEP-NETs

Regimen	Study design	Tumor type	n	RR (%)	PFS or TTP (mo)	One year survival (%)	Reference
Angiogenesis inhibitors
Temozolamide + thalidomide	Phase II, single arm	Mixed carcinoid, pancreas and pheochromocytoma	29	45 (p)	13.5	79	Kulke^Citation17
				7(c)
Bev/Oct vs IFNα/Oct†	Phase II, randomized	Carcinoid only	22	18	—	93	Yao^Citation27
			22	0
Tyrosine kinase inhibitors
Sunitinib	Phase II, Single arm	Mixed carcinoid and pancreas	109	17 (p)	7.7 (p)	81	Kulke^Citation32
				2 (c)	10.2 (c)	83
Sunitinib vs placebo	Phase III, randomized	Pancreatic only	75	–	11.1	–	Raymond^Citation33
			79		5.5
mTOR inhibitors
RAD001 vs RAD001+ Oct	Phase II, two arm	Pancreatic only	115	7.8%	9.3	50	Yao^Citation41
			45	4.4%	12.9	90

Abbreviations: Bev, bevacizumab; IFNα, interferon alpha; Oct, octreotide; C, carcinoid; P, pancreas; PFS, progression-free survival; RR, response rate; TTP, time to progression.

Note:

† crossover allowed at 18 weeks.

Figure 1 Response to bevacizumab, capecitabine, and oxaliplatin.

On left are two cuts demonstrating the characteristic appearance of enhancing liver lesions (note that aorta is bright white signifying arterial phase scan) in a patient with a pancreatic neuroendocrine tumor. On right are corresponding cuts after 2 cycles (6 weeks) of bevacizumab, capecitabine, and oxaliplatin demonstrating marked decrease in vascularity of lesions.

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