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Advanced small-bowel well-differentiated neuroendocrine tumours : An international survey of practice on 3(rd)-line treatment

Lamarca, Angela (författare)
Univ Manchester, Christie NHS Fdn Trust, European Neuroendocrine Tumor Soc Ctr Excellence, Dept Med Oncol, Wilmslow Rd, Manchester M20 4BX, Lancs, England.
Cives, Mauro (författare)
Univ Bari Aldo Moro, Dept Biomed Sci & Human Oncol, I-70121 Bari, Italy.
de Mestier, Louis (författare)
Univ Paris Diderot, European Neuroendocrine Tumor Soc Ctr Excellence, Dept Gastroenterol & Pancreatol, F-75006 Clichy, France.
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Crona, Joakim (författare)
Uppsala universitet,Endokrinkirurgi,Endokrin tumörbiologi,Experimentell kirurgi
Spada, Francesca (författare)
European Inst Oncol, Gastrointestinal Med Oncol & Neuroendocrine Tumor, I-20141 Milan, Italy.
Öberg, Kjell, 1946- (författare)
Uppsala universitet,Science for Life Laboratory, SciLifeLab,Endokrin tumörbiologi
Pavel, Marianne (författare)
Univ Klinikum Erlangen, Dept Endocrinol, D-91054 Erlangen, Germany.
Alonso-Gordoa, Teresa (författare)
Univ Alcala De Henares, Univ Hosp Ramon & Cajal, Ramon & Cajal Hlth Res Inst, Med Oncol Dept, Madrid 28034, Spain.
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Univ Manchester, Christie NHS Fdn Trust, European Neuroendocrine Tumor Soc Ctr Excellence, Dept Med Oncol, Wilmslow Rd, Manchester M20 4BX, Lancs, England Univ Bari Aldo Moro, Dept Biomed Sci & Human Oncol, I-70121 Bari, Italy. (creator_code:org_t)
Ingår i: World Journal of Gastroenterology. - : BAISHIDENG PUBLISHING GROUP INC. - 1007-9327 .- 2219-2840. ; 27:10, s. 976-989
  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
  • BACKGROUND Somatostatin analogues are an established first-line therapy for well differentiated small bowel neuroendocrine tumours (Wd-SBNETs), while and peptide receptor radionuclide therapy (PRRT) is frequently used as a second-line therapy. Adequate treatment selection of third-line treatment remains challenging due to the limited prospective data currently available on the best therapeutic sequence. AIM To understand current practice and rationale for decision-making by physicians in the 3(rd)-line setting by building an online survey. METHODS Weighted average (WA) of likelihood of usage between responders (1 very unlikely; 4 very likely) was used to reflect the relevance of factors explored. RESULTS Replies from representatives of 28 centers were received (5/8/2020-21/9/2020); medical oncologist (53.6%), gastroenterologist (17.9%); United Kingdom (21.4%), Spain (17.9%), Italy (14.3%). Majority from European Neuroendocrine Tumor Society (ENETS) Centres of Excellence (57.1%), who followed ENETS guidelines (82.1%). Generally speaking, 3(rd)-line treatment for Wd-SBNETs was: everolimus (EVE) (66.7%), PRRT (18.5%), liver embolization (LE) (7.4%) and interferon-alpha (IFN) (3.7%); chemotherapy (0%); decision was based on clinical trial data (59.3%), or personal experience (22.2%). EVE was most likely used if Ki-67 < 10% (WA 3.27/4) or age < 70 years (WA 3.23/4), in the 3(rd)-line setting (WA 3.23/4); regardless of presence/absence of carcinoid syndrome (CS), rate of progression or extent of disease. Chemotherapy was mainly utilised only if rapid progression (within 6 mo) (WA 3.35/4), Ki-67 10%-20% (WA 2.77/4), negative somatostatin receptor imaging (WA 2.65/4) or high tumour burden (WA 2.77/4); temozolomide or streptozocin was used with capecitabine or 5-fluorouracil (5-FU) (57.7%), FOLFOX (5-FU combined with oxaliplatin) (23.1%). LE was selected if presence of CS (WA 3.24/4) or Ki-67 < 10% (WA 2.8/4), after progression to other treatments (WA 2.8/4). IFN was rarely used (WA 1.3/4). CONCLUSION Everolimus was the most frequently used therapeutic option in the third-line setting. The most important factors for decision-making included Ki-67, rate of progression, functionality and tumour burden; since this decision is based on multiple factors, it highlights the need for a multidisciplinary assessment.


MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Gastroenterology and Hepatology (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Gastroenterologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine (hsv//eng)


Neuroendocrine tumour
Small bowel

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