Medical Oncology

, 30:664 | Cite as

Feasibility and efficacy of combined cisplatin plus irinotecan chemotherapy for gastroenteropancreatic neuroendocrine carcinomas

  • Z. H. Lu
  • J. Li
  • M. Lu
  • X. T. Zhang
  • J. Li
  • J. Zhou
  • X. C. Wang
  • J. F. Gong
  • J. Gao
  • Y. Li
  • L. Shen
Original Paper

Abstract

No standard treatment is currently available for gastroenteropancreatic neuroendocrine carcinomas (GEP-NEC). Therefore, we conducted this study to evaluate the effect of the combination of irinotecan and cisplatin in the treatment of GEP-NECs. Clinical data of 16 locally advanced or metastatic GEP-NEC patients treated with irinotecan plus cisplatin regimen in our center from September 2009 to August 2011 were reviewed. The regimen included 2-week cycles of 180 mg/m2 irinotecan and 50 mg/m2 cisplatin on day 1. Median age was 57 years. The overall response rate was 57.1 %, with a disease control rate of 78.6 %. One patient achieved pathologic complete response and underwent esophagectomy after chemotherapy. Two patients who had gotten progressive disease were given sequential octreotide long-acting release (LAR) treatment and got disease progression again within 1 month. Six patients who achieved disease control received octreotide LAR as maintenance treatment. The total number of cycles of octreotide was 41, with a median of 4.5 (3–20 cycles). The progression-free survival was 5.5 months, with overall survival of 10.6 months. Grades 3–4 hematological adverse events (AEs) occurred in 10 patients (62.5 %) and 3 patients (18.7 %) suffered grades 3–4 non-hematological AEs; no patient died of AEs. The irinotecan plus cisplatin chemotherapy is moderately effective and tolerable well tolerated in advanced or metastatic GEP-NEC patients; octreotide LAR may be a good maintenance treatment and should be considered as a treatment option for these patients in the future.

Keywords

Gastroenteropancreatic neuroendocrine carcinoma Octreotide Chemotherapy Overall survival 

Notes

Conflict of interest

The authors have declared no conflicts of interest.

References

  1. 1.
    Yao JC, Hassan M, Phan AC, et al. One hundred years after carcinoid: epidemiology of and prognostic factors for neuroendocrine tumors in 35, 825 cases in the United States. J Clin Oncol. 2008;26(18):3063–72.PubMedCrossRefGoogle Scholar
  2. 2.
    Niederle MB, Hackl M, Kaserer K, et al. Gastroenteropancreatic neuroendocrine tumours: the current incidence and staging based on the WHO and European Neuroendocrine Tumour Society classification: an analysis based on prospectively collected parameters. Endocr Relat Cancer. 2010;17(4):909–18.PubMedCrossRefGoogle Scholar
  3. 3.
    Bosman FT, Carneiro F, Hruban RH, et al. WHO classification of tumours of the digestive system. Lyon: IARC Press; 2010. p. 26–7.Google Scholar
  4. 4.
    Mitry E, Rougier P. The treatment of undifferentiated neuroendocrine tumors. Crit Rev Oncol Hematol. 2001;37(1):47–51.PubMedCrossRefGoogle Scholar
  5. 5.
    Johnson LA, Lavin P, Moertel CG, et al. Carcinoids: the association of histologic growth pattern and survival. Cancer. 1983;51(5):882–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Fazio N, Spada F, Giovannini M. Chemotherapy in gastroenteropancreatic (GEP) neuroendocrine carcinomas (NEC): a critical view. Cancer Treat Rev. 2013;39(3):270–4.PubMedCrossRefGoogle Scholar
  7. 7.
    Plockinger U, Rindi G, Arnold R, et al. Guidelines for the diagnosis and treatment of neuroendocrine gastrointestinal tumours. A consensus statement on behalf of the European Neuroendocrine Tumour Society (ENETS). Neuroendocrinology. 2004;80(6):394–424.PubMedCrossRefGoogle Scholar
  8. 8.
    Moertel CG, Kvols LK, O’Connell MJ, et al. Treatment of neuroendocrine carcinomas with combined etoposide and cisplatin. Evidence of major therapeutic activity in the anaplastic variants of these neoplasms. Cancer. 1991;68(2):227–32.PubMedCrossRefGoogle Scholar
  9. 9.
    Mitry E, Baudin E, Ducreux M, et al. Treatment of poorly differentiated neuroendocrine tumours with etoposide and cisplatin. Br J Cancer. 1999;81(8):1351–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Fjallskog ML, Granberg DP, Welin SL, et al. Treatment with cisplatin and etoposide in patients with neuroendocrine tumors. Cancer. 2001;92(5):1101–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Noda K, Nishiwaki Y, Kawahara M, et al. Irinotecan plus cisplatin compared with etoposide plus cisplatin for extensive small-cell lung cancer. N Engl J Med. 2002;346(2):85–91.PubMedCrossRefGoogle Scholar
  12. 12.
    Godwin JD. Carcinoid tumors. An analysis of 2837 cases. Cancer. 1975;36(2):560–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Botch K, Ahren B, Ahlman H, et al. Gastric carcinoids. Biologic behavior and prognosis after differentiated treatment in relation to type. Ann Surg. 2005;242(1):64–73.CrossRefGoogle Scholar
  14. 14.
    Okita NT, Kato K, Takahari D, et al. Neuroendocrine tumors of the stomach: chemotherapy with cisplatin plus irinotecan is effective for gastric poorly differentiated neuroendocrine carcinoma. Gastric Cancer. 2011;14(2):161–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Matsui K, Kitagawa M, Miwa A, et al. Small cell carcinoma of the stomach: a clinicopathologic study of 17 cases. Am J Gastroenterol. 1991;86(9):1167–75.PubMedGoogle Scholar
  16. 16.
    Arai K, Matsuda M. Gastric small-cell carcinoma in Japan: a case report and review of the literature. Am J Clin Oncol. 1998;21(5):458–61.PubMedCrossRefGoogle Scholar
  17. 17.
    Huang Q, Wu H, Nie L, Shi J, et al. Primary high-grade neuroendocrine carcinoma of the esophagus: a clinicopathologic and immunohistochemical study of 42 resection cases. Am J Surg Pathol. 2013;37(4):467–83.PubMedCrossRefGoogle Scholar
  18. 18.
    Iwasa S, Morizane C, Okusaka T, et al. Cisplatin and etoposide as first-line chemotherapy for poorly differentiated neuroendocrine carcinoma of the hepatobiliary tract and pancreas. Jpn J Clin Oncol. 2010;40(4):313–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Hanna N, Bunn PA Jr, Langer C, et al. Randomized phase III trial comparing irinotecan/cisplatin with etoposide/cisplatin in patients with previously untreated extensive-stage disease small-cell lung cancer. J Clin Oncol. 2006;24(13):2038–43.PubMedCrossRefGoogle Scholar
  20. 20.
    Nakano K, Takahashi S, Yuasa T, et al. Feasibility and efficacy of combined cisplatin and irinotecan chemotherapy for poorly differentiated neuroendocrine carcinomas. Jpn J Clin Oncol. 2012;42(8):697–703.PubMedCrossRefGoogle Scholar
  21. 21.
    Rinke A, Muller HH, Schade-Brittinger C, et al. Placebo controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors: a report from the PROMID Study Group. J Clin Oncol. 2009;27(28):4656–63.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Z. H. Lu
    • 1
  • J. Li
    • 1
  • M. Lu
    • 1
  • X. T. Zhang
    • 1
  • J. Li
    • 1
  • J. Zhou
    • 1
  • X. C. Wang
    • 1
  • J. F. Gong
    • 1
  • J. Gao
    • 1
  • Y. Li
    • 1
  • L. Shen
    • 1
  1. 1.Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI OncologyPeking University School of Oncology, Beijing Cancer Hospital and InstituteBeijingChina

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