Efficacy of a chemotherapy combination for the treatment of metastatic neuroendocrine tumours

Objectives: Neuroendocrine tumours (NETs) are heterogeneous neoplasms, for which there is no standard treatment. We have previously proposed an effective poly chemotherapy (5-fluorouracil. dacarbazine and epirubicin), which only produced objective responses of brief duration. The present study aimed to assess in a multidisciplinary manner the efficacy of the same regimen at intensified doses in patients with advanced NETs. Patients and methods: Eighty-two consecutive patients entered the study, of whom 21 had inoperable. locally advanced disease and 61 had metastatic disease. Seventy-two patients were evaluated for objective, biochemical and subjective responses. Response rate, time to progression (TTP) and overall survival (OS) were evaluated based on histotype. Results: An objective response was observed in 20 patients (intention-to-treat and standard analysis 24.4% and 27.8%. respectively), Complete biochemical and subjective responses were obtained in 25.1% and 38.9% of the cases. The median duration of treatment was 4 months and the objective responses had a median duration of 38 months. After a 60-month follow-up the median TTP and OS were 21 and 38 months. respectively. Conclusions: Our polychemotherapy regimen is effective. with long duration, and is well tolerated both for gastroenteropancreatic and lung NETs, as well as for tumours with a more aggressive clinical behaviour. The new WHO endocrine tumour histotyping, examining also the tumour biology, may give additional information for selecting patients to chemotherapy.