BACKGROUND: Well-differentiated neuroendocrine tumors are treated primarily with somatostatin analogs and interferon-alpha. It is not clear what therapy should be applied after failed biotherapy. Our aim was to establish whether patients whose tumors rapidly progress under biotherapy may benefit from chemotherapy. PATIENTS AND METHODS: In 10 patients with metastatic neuroendocrine tumors (4 foregut, 3 midgut, 1 retroperitoneal, and 2 of unknown origin) streptozotocin and doxorubicin were used as second-line or third-line therapy. Tumor response was assessed by computed tomography of the abdomen and thorax and measurement of tumor secretion products (serum chromogranin A, urinary 5-hydroxyindoleacetic acid). RESULTS: Three patients showed a radiological response over a mean time of 30 mo (range: 7-67 mo). Median survival after initiation of chemotherapy was 50 mo in patients with a response and 8 mo in non-responders. Three patients developed major side effects (nephrotoxicity, diabetes, and encephalopathy). CONCLUSION: Streptozotocin and doxorubicin produce poor response rates in patients with progressive neuroendocrine tumors after failed biotherapy, but may prolong life in those patients who show a tumor response.
BACKGROUND: Well-differentiated neuroendocrine tumors are treated primarily with somatostatin analogs and interferon-alpha. It is not clear what therapy should be applied after failed biotherapy. Our aim was to establish whether patients whose tumors rapidly progress under biotherapy may benefit from chemotherapy. PATIENTS AND METHODS: In 10 patients with metastatic neuroendocrine tumors (4 foregut, 3 midgut, 1 retroperitoneal, and 2 of unknown origin) streptozotocin and doxorubicin were used as second-line or third-line therapy. Tumor response was assessed by computed tomography of the abdomen and thorax and measurement of tumor secretion products (serum chromogranin A, urinary 5-hydroxyindoleacetic acid). RESULTS: Three patients showed a radiological response over a mean time of 30 mo (range: 7-67 mo). Median survival after initiation of chemotherapy was 50 mo in patients with a response and 8 mo in non-responders. Three patients developed major side effects (nephrotoxicity, diabetes, and encephalopathy). CONCLUSION:Streptozotocin and doxorubicin produce poor response rates in patients with progressive neuroendocrine tumors after failed biotherapy, but may prolong life in those patients who show a tumor response.
Authors: Maria P Brizzi; Alfredo Berruti; Anna Ferrero; Enrica Milanesi; Marco Volante; Federico Castiglione; Nadia Birocco; Sebastiano Bombaci; Davide Perroni; Benedetta Ferretti; Oscar Alabiso; Libero Ciuffreda; Oscar Bertetto; Mauro Papotti; Luigi Dogliotti Journal: BMC Cancer Date: 2009-11-03 Impact factor: 4.430