Metastatic neuroendocrine neoplasia treatments in patients over 70 years of age

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Abstract

The incidence of neuroendocrine neoplasia (NEN) is higher in individuals ≥70 years of age (elderly), who are underrepresented in clinical trials because of comorbidities and low performance status. We retrospectively analyzed the outcome of elderly patients with metastatic NEN (mNEN). Comorbidities were summarized by Charlson Comorbidity Index (CCI), Kaplan-Meier method was applied to estimate overall survival (OS) and Cox's proportional hazard model was used to assess the impact of known prognostic factors. We retrieved data on 145 mNEN patients ≥70 years seen at our center from June 2007 to March 2016. Fifty-six (38.6%) were ≥75 years. ECOG PS was 0 in 45.7% of cases and CCI was 0 in 41.0% and 1 in 37.4%. 75.4% of patients had grade (G) 1/G2 NEN and 24.6%, G3. Octreoscan®/Gallium PET/CT and FDG-PET/CT were positive in 94.2% and 70.3% of cases, respectively. Median follow-up was 72.3 (53.2-85.1) months. Seventy-nine patients received first-line somatostatin analogs (SSA), 23 peptide receptor radionuclide therapy (PRRT), and 36 chemotherapy (CHT). Seven did not undergo first-line therapy and 102 received more than one line. Median overall survival (mOS) was 5.1 years (95%CI:3.4-6.6). No differences in mOS were seen according to CCI. First-line PRRT patients had a mOS of 6.5 years (95%CI:3.3-not reached [NR]), SSA 5.7 years (95%CI:4.2-7) and CHT 5.9 years (95%CI:0.4-NR). mOS in CHT-treated G3 patients was 1.5 years (1.0-2.5). ECOG PS and FDG PET/CT were identified as independent prognostic factors. Results suggest that the above treatments positively impacted OS in elderly mNEN patients, including those ≥75 years.

Original languageEnglish
JournalEndocrine Connections
DOIs
Publication statusE-pub ahead of print - Dec 1 2018

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Comorbidity
Survival
Neoplasms
Peptide Receptors
Somatostatin
Drug Therapy
Radioisotopes
Therapeutics
Gallium
Proportional Hazards Models
Clinical Trials
Incidence

Cite this

@article{b7711d95b7314d8386b09b80aeee2822,
title = "Metastatic neuroendocrine neoplasia treatments in patients over 70 years of age",
abstract = "The incidence of neuroendocrine neoplasia (NEN) is higher in individuals ≥70 years of age (elderly), who are underrepresented in clinical trials because of comorbidities and low performance status. We retrospectively analyzed the outcome of elderly patients with metastatic NEN (mNEN). Comorbidities were summarized by Charlson Comorbidity Index (CCI), Kaplan-Meier method was applied to estimate overall survival (OS) and Cox's proportional hazard model was used to assess the impact of known prognostic factors. We retrieved data on 145 mNEN patients ≥70 years seen at our center from June 2007 to March 2016. Fifty-six (38.6{\%}) were ≥75 years. ECOG PS was 0 in 45.7{\%} of cases and CCI was 0 in 41.0{\%} and 1 in 37.4{\%}. 75.4{\%} of patients had grade (G) 1/G2 NEN and 24.6{\%}, G3. Octreoscan{\circledR}/Gallium PET/CT and FDG-PET/CT were positive in 94.2{\%} and 70.3{\%} of cases, respectively. Median follow-up was 72.3 (53.2-85.1) months. Seventy-nine patients received first-line somatostatin analogs (SSA), 23 peptide receptor radionuclide therapy (PRRT), and 36 chemotherapy (CHT). Seven did not undergo first-line therapy and 102 received more than one line. Median overall survival (mOS) was 5.1 years (95{\%}CI:3.4-6.6). No differences in mOS were seen according to CCI. First-line PRRT patients had a mOS of 6.5 years (95{\%}CI:3.3-not reached [NR]), SSA 5.7 years (95{\%}CI:4.2-7) and CHT 5.9 years (95{\%}CI:0.4-NR). mOS in CHT-treated G3 patients was 1.5 years (1.0-2.5). ECOG PS and FDG PET/CT were identified as independent prognostic factors. Results suggest that the above treatments positively impacted OS in elderly mNEN patients, including those ≥75 years.",
author = "Alberto Bongiovanni and Federica Recine and Flavia Foca and Valentina Fausti and Nada Riva and Greta Fabbri and Stefano Severi and Chiara Liverani and {De Vita}, Alessandro and Chiara Spadazzi and Giacomo Miserocchi and Laura Mercatali and Dino Amadori and Toni Ibrahim",
year = "2018",
month = "12",
day = "1",
doi = "10.1530/EC-18-0478",
language = "English",
journal = "Endocrine Connections",
issn = "2049-3614",
publisher = "BioScientifica Ltd.",

}

TY - JOUR

T1 - Metastatic neuroendocrine neoplasia treatments in patients over 70 years of age

AU - Bongiovanni, Alberto

AU - Recine, Federica

AU - Foca, Flavia

AU - Fausti, Valentina

AU - Riva, Nada

AU - Fabbri, Greta

AU - Severi, Stefano

AU - Liverani, Chiara

AU - De Vita, Alessandro

AU - Spadazzi, Chiara

AU - Miserocchi, Giacomo

AU - Mercatali, Laura

AU - Amadori, Dino

AU - Ibrahim, Toni

PY - 2018/12/1

Y1 - 2018/12/1

N2 - The incidence of neuroendocrine neoplasia (NEN) is higher in individuals ≥70 years of age (elderly), who are underrepresented in clinical trials because of comorbidities and low performance status. We retrospectively analyzed the outcome of elderly patients with metastatic NEN (mNEN). Comorbidities were summarized by Charlson Comorbidity Index (CCI), Kaplan-Meier method was applied to estimate overall survival (OS) and Cox's proportional hazard model was used to assess the impact of known prognostic factors. We retrieved data on 145 mNEN patients ≥70 years seen at our center from June 2007 to March 2016. Fifty-six (38.6%) were ≥75 years. ECOG PS was 0 in 45.7% of cases and CCI was 0 in 41.0% and 1 in 37.4%. 75.4% of patients had grade (G) 1/G2 NEN and 24.6%, G3. Octreoscan®/Gallium PET/CT and FDG-PET/CT were positive in 94.2% and 70.3% of cases, respectively. Median follow-up was 72.3 (53.2-85.1) months. Seventy-nine patients received first-line somatostatin analogs (SSA), 23 peptide receptor radionuclide therapy (PRRT), and 36 chemotherapy (CHT). Seven did not undergo first-line therapy and 102 received more than one line. Median overall survival (mOS) was 5.1 years (95%CI:3.4-6.6). No differences in mOS were seen according to CCI. First-line PRRT patients had a mOS of 6.5 years (95%CI:3.3-not reached [NR]), SSA 5.7 years (95%CI:4.2-7) and CHT 5.9 years (95%CI:0.4-NR). mOS in CHT-treated G3 patients was 1.5 years (1.0-2.5). ECOG PS and FDG PET/CT were identified as independent prognostic factors. Results suggest that the above treatments positively impacted OS in elderly mNEN patients, including those ≥75 years.

AB - The incidence of neuroendocrine neoplasia (NEN) is higher in individuals ≥70 years of age (elderly), who are underrepresented in clinical trials because of comorbidities and low performance status. We retrospectively analyzed the outcome of elderly patients with metastatic NEN (mNEN). Comorbidities were summarized by Charlson Comorbidity Index (CCI), Kaplan-Meier method was applied to estimate overall survival (OS) and Cox's proportional hazard model was used to assess the impact of known prognostic factors. We retrieved data on 145 mNEN patients ≥70 years seen at our center from June 2007 to March 2016. Fifty-six (38.6%) were ≥75 years. ECOG PS was 0 in 45.7% of cases and CCI was 0 in 41.0% and 1 in 37.4%. 75.4% of patients had grade (G) 1/G2 NEN and 24.6%, G3. Octreoscan®/Gallium PET/CT and FDG-PET/CT were positive in 94.2% and 70.3% of cases, respectively. Median follow-up was 72.3 (53.2-85.1) months. Seventy-nine patients received first-line somatostatin analogs (SSA), 23 peptide receptor radionuclide therapy (PRRT), and 36 chemotherapy (CHT). Seven did not undergo first-line therapy and 102 received more than one line. Median overall survival (mOS) was 5.1 years (95%CI:3.4-6.6). No differences in mOS were seen according to CCI. First-line PRRT patients had a mOS of 6.5 years (95%CI:3.3-not reached [NR]), SSA 5.7 years (95%CI:4.2-7) and CHT 5.9 years (95%CI:0.4-NR). mOS in CHT-treated G3 patients was 1.5 years (1.0-2.5). ECOG PS and FDG PET/CT were identified as independent prognostic factors. Results suggest that the above treatments positively impacted OS in elderly mNEN patients, including those ≥75 years.

U2 - 10.1530/EC-18-0478

DO - 10.1530/EC-18-0478

M3 - Article

C2 - 30530877

JO - Endocrine Connections

JF - Endocrine Connections

SN - 2049-3614

ER -