Department of Hematology and Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, Japan.
Jpn J Clin Oncol. 2012 Aug;42(8):697-703. doi: 10.1093/jjco/hys085. Epub 2012 Jun 13.
No standard treatment has been established for poorly differentiated neuroendocrine carcinoma; the usual recommended treatment is based on the strategy for small cell lung carcinoma. The aim of this study was to evaluate the response of poorly differentiated neuroendocrine carcinoma to the combination of irinotecan and cisplatin in one institution.
We retrospectively reviewed 50 poorly differentiated neuroendocrine carcinoma patients treated from September 2005 to April 2011 in our institution. Patients were divided into two stages: limited disease or extensive disease. Forty-four patients received the combination chemotherapy of irinotecan and cisplatin, consisting of 4-week cycles of 60 mg/m(2) irinotecan on days 1, 8, 15 and 60 mg/m(2) cisplatin on day 1.
Median age was 60 years. Median follow-up time was 11.4 months. Overall survival did not reach the median, and 1-year overall survival was 67%. The response rate was 50% (64% at first line), and progression-free survival was 4.8 months (7.3 months at first line). Grade 3-4 hematologic adverse events were seen in 29 patients (66%) and Grade 3-4 non-hematologic adverse events were seen in 20 patients (45%), but no patients died of adverse events. Multivariate analysis showed a statistically significant relationship with neuron-specific enolase elevation and poor overall survival (P= 0.016, hazard ratio 6.261, 95% confidence interval). The combination chemotherapy of irinotecan and cisplatin is moderately effective and feasible, and it should be considered as a treatment option for poorly differentiated neuroendocrine carcinoma.
未分化神经内分泌癌尚无标准治疗方法，通常推荐的治疗方法基于小细胞肺癌的治疗策略。本研究旨在评估在单一机构中伊立替康联合顺铂治疗未分化神经内分泌癌的疗效。
我们回顾性分析了 2005 年 9 月至 2011 年 4 月在我院治疗的 50 例未分化神经内分泌癌患者。患者分为局限性疾病或广泛性疾病两个阶段。44 例患者接受伊立替康联合顺铂联合化疗，方案为 4 周周期，第 1、8、15 天给予 60mg/m2伊立替康，第 1 天给予 60mg/m2顺铂。
中位年龄为 60 岁。中位随访时间为 11.4 个月。总生存时间未达到中位数，1 年总生存率为 67%。总缓解率为 50%（一线治疗的缓解率为 64%），无进展生存期为 4.8 个月（一线治疗的无进展生存期为 7.3 个月）。29 例患者（66%）出现 3-4 级血液学不良事件，20 例患者（45%）出现 3-4 级非血液学不良事件，但无患者因不良事件死亡。多因素分析显示神经元特异性烯醇化酶升高与总生存不良有显著的统计学关系（P=0.016，风险比 6.261，95%置信区间）。伊立替康联合顺铂联合化疗具有一定的疗效，且具有可行性，可作为未分化神经内分泌癌的治疗选择。
