Purpose: The role of chemotherapy in low/intermediate grade neuroendocrine tumors (NETs) is still debated. We present the results of an Italian multicenter retrospective study, evaluating activity and toxicity of oxaliplatin-based chemotherapy in patients with advanced NETs. Methods: Clinical records from 5 referral centers were reviewed. Disease control rate (DCR) corresponding to PR+SD (partial response + stable disease) at 6 months, progression free survival (PFS), overall survival (OS) and toxicity were calculated. Ki67 labeling-index, grade of differentiation and excision-repair-cross-complementing group-1 (ERCC-1) were analyzed in tissue tumor samples. Results: Seventy-eight patients entered the study. Primary sites were: pancreas in 46, gastrointestinal in 24, lung in 19, and unknown in 10% patients. The vast majority were G2 (2010 WHO classification). Eighty-six percent of patients were metastatic, 87% pretreated and progressive to previous therapies. 65% patients received capecitabine/oxaliplatin (CAPOX), 6% gemcitabine/oxaliplatin (GEMOX), 29% leucovorin/fluorouracil/oxaliplatin (FOLFOX-6). Partial response occurred in 26% patients, half of them with pancreatic NETs (PNETs), and SD in 54%. With 21 months median follow-up, the median PFS and OS were 8 and 32 months with 70 and 45 events, respectively. The most frequent G3 toxicities were neurological and gastrointestinal. ERCC-1 immunohistochemical over-expression was positive in 4/28 evaluated samples, with no significant correlation with clinical outcome. Conclusion: This analysis suggests that oxaliplatin-based chemotherapy can be active with a manageable safety profile in advanced NETs irrespective of the primary sites and tumor grade. The 80% DCR and 8 months PFS could justify a prospective study in NETs with intermediate biological characteristics, especially with pancreatic primary.
ASJC Scopus subject areas
- Endocrinology, Diabetes and Metabolism
- Endocrine and Autonomic Systems
- Cellular and Molecular Neuroscience