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CC BY 4.0 · Brazilian Journal of Oncology 2022; 18: e-20220285
DOI: 10.5935/2526-8732.20220285
Original Article
Clinical Oncology

Using chemotherapy against metastatic pancreatic neuroendocrine neoplasm: how aggressively do we treat it? Real world data from a Brazilian Cancer Center

Usando quimioterapia contra neoplasia neuroendócrina pancreática metastática: o quão agressivamente tratamos? Dados de mundo real de um Cancer Center brasileiro
Mauro Daniel Spina Donadio 
1   AC Camargo Cancer Center, Clinical Oncology - São Paulo - São Paulo - Brazil
,
Victor Hugo Fonseca de Jesus
1   AC Camargo Cancer Center, Clinical Oncology - São Paulo - São Paulo - Brazil
,
Milton José Barros
1   AC Camargo Cancer Center, Clinical Oncology - São Paulo - São Paulo - Brazil
› Author Affiliations Financial support: None to declare.
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ABSTRACT

Introduction: Pancreatic neuroendocrine neoplasms (pNEN) have poor prognosis. Available treatment options are limited. We aimed to evaluate the clinical characteristics and outcomes in patients with pNEN undergoing systemic chemotherapy.

Methods: Retrospective study of patients with metastatic pNEN diagnosed between January 2000 and April 2018 in A.C. Camargo Cancer Center. We evaluated epidemiological characteristics and outcomes of patients who received systemic chemotherapy between the first and third-lines.

Results: 35 patients with median age of 54.4 years; 51.4% had diabetes mellitus and 62.9% had smoking history. Most primary tumors were located in pancreatic body or tail and 34.3% were described as well or moderately differentiated, 40% were of high grade. Overall, chemotherapy from first to third-line was prescribed 50 times, 62% consisted of platin doublet, the chosen schema 50% of times when Ki-67<20%, 55.5% for Ki-67 between 20% and 55% and 66.7% for Ki-67>55%. The median PFS and RR were 7.8 months and 40.7%; 13 months and 33.3% and 3 months and 0% in the first, second and third-line, respectively. The estimated OS was 53.4 months. We found that female (HR 2.8, p=0.034), DM (HR 4.5, p=0.004), smoking (HR 3.5, p=0.017), high grade tumors (HR 3.8, p=0.025) and tumors localized in head/ neck of the pancreas (HR 7.1, p<0.001) were negative prognostic factors for OS in univariate analysis.

Conclusion: Our real world data shows that doublet platin is a preferred and active schema for treating pNEN, especially in first and second line. It brings the greatest benefit for undifferentiated tumors. Nevertheless, the prognosis remains poor and some factors may contribute to worse outcomes, such as female gender, silent tumors that do not manifest DM, poorly differentiated tumours, smoking and location in the head and neck of the pancreas.

RESUMO

Introdução: As neoplasias neuroendócrinas pancreáticas (pNEN) têm mau prognóstico. As opções de tratamento disponíveis são limitadas. Nosso objetivo foi avaliar as características clínicas e os resultados em pacientes com pNEN submetidos à quimioterapia sistêmica.

Métodos: Estudo retrospectivo de pacientes com pNEN metastático diagnosticados entre janeiro de 2000 e abril de 2018 no A.C. Camargo Cancer Center. Avaliamos características epidemiológicas e desfechos de pacientes que receberam quimioterapia sistêmica entre primeira e terceira linha.

Resultados: 35 pacientes com idade mediana de 54,4 anos; 51,4% tinham diabetes mellitus e 62,9% tinham história de tabagismo. A maioria dos tumores primários estava localizada no corpo ou cauda do pâncreas e 34.3% foi descrito como bem ou moderadamente diferenciados, 40% eram de alto grau. No geral, a quimioterapia de primeira a terceira linha foi prescrita 50 vezes, 62% consistiu em doublet de platina, esquema escolhido em 50% das vezes quando Ki-67<20%, 55,5% para Ki-67 entre 20% e 55% e 66,7% para Ki-67>55%. As medianas de SLP e TR foram de 7,8 meses e 40,7%; 13 meses e 33,3% e 3 meses e 0% de primeira, segunda e terceira linhas, respectivamente. A SG estimada foi de 53,4 meses. Encontramos que o sexo feminino (HR 2,8, p=0,034), DM (HR 4,5, p=0,004), tabagismo (HR 3,5, p=0,017), tumores de alto grau (HR 3,8, p=0,025) e tumores localizados na cabeça/colo do pâncreas (HR 7,1, p<0,001) foram fatores prognósticos negativos para SG na análise univariada.

Conclusão: Nossos dados do mundo real mostram que a platina dupla é um esquema preferencial e ativo para o tratamento de pNEN, especialmente em primeira e segunda linha. Traz o maior benefício para tumores indiferenciados. Apesar disso, o prognóstico permanece ruim e alguns fatores podem contribuir para piores desfechos, como sexo feminino, tumores silenciosos que não manifestam DM, tumores pouco diferenciados, tabagismo e localização na cabeça e pescoço do pâncreas.

Keywords:

Neuroendocrine tumors - Pancreatic neoplasms - Drug therapy

Descritores:

Tumores neuroendócrinos - Neoplasias pancreáticas - Terapia medicamentosa

Author's contribution:

All authors contributed equally for the manuscript.




Publication History

Received: 30 June 2021

Accepted: 15 October 2021

Article published online:
22 February 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Mauro Daniel Spina Donadio, Victor Hugo Fonseca de Jesus, Milton José Barros. Using chemotherapy against metastatic pancreatic neuroendocrine neoplasm: how aggressively do we treat it? Real world data from a Brazilian Cancer Center. Brazilian Journal of Oncology 2022; 18: e-20220285.
DOI: 10.5935/2526-8732.20220285
 

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