Pôle des Maladies de L'appareil Digestif, Service de Gastroentérologie-Pancréatologie, Hôpital Beaujon, Clichy, France.
Endocr Relat Cancer. 2012 Nov 6;19(6):751-7. doi: 10.1530/ERC-12-0002. Print 2012 Dec.
Patients with neuroendocrine carcinomas (NECs) grade 3 have a poor prognosis. Etoposide-platinum combination is the standard chemotherapy but the role of a second-line therapy remains unknown. Irinotecan alone or in combination has shown some efficacy in patients treated for small cell lung cancer which had pathological similarities with neuroendocine tumors. The aim of this study is to determine safety and efficacy of the FOLFIRI regimen in patients with NECs grade 3 after failure of etoposide-platinum combination. This study was retrospective, including patients with NECs grade 3 and treated with the FOLFIRI regimen after progression or toxicity of etoposide-platinum combination in first-line. Patients with Eastern Cooperative Oncology Group (ECOG) performance status ≥3 and/or serum alkaline phosphatase ≥5×upper limit of normal value (ULN) and/or bilirubin ≥1.5×ULN were excluded. Among 39 patients who failed etoposide-platinum combination, 19 (49%; 12 women, median age 53 (29-78) years) received the FOLFIRI regimen with a median number of 6 (1-16) courses. Six patients (31%) had at least one episode of grades 3-4 toxicity (neutropenia, n=3; diarrhea, n=3) without toxic death. Six patients (31%) had objective response, 6 (31%) stable disease, and 7 (38%) tumor progression. Median progression-free survival under FOLFIRI was 4 months. Overall survival was 18 vs 6.8 months in noneligible patients. FOLFIRI regimen is a safe and potentially efficient chemotherapy given as second-line in patients with NECs grade 3 who remain in good condition and with correct liver tests after failure of etoposide-platinum combination. These results should be confirmed in a future prospective study.
患有神经内分泌癌（NECs）3 级的患者预后较差。依托泊苷-铂类联合化疗是标准治疗方案，但二线治疗的作用仍不清楚。伊立替康单独或联合治疗小细胞肺癌患者显示出一定疗效，小细胞肺癌与神经内分泌肿瘤在病理上具有相似性。本研究旨在确定 FOLFIRI 方案在依托泊苷-铂类联合化疗失败后治疗 NECs 3 级患者的安全性和有效性。该研究为回顾性研究，纳入了 NECs 3 级患者，这些患者在一线治疗中因依托泊苷-铂类联合治疗的进展或毒性而接受 FOLFIRI 方案治疗。排除 Eastern Cooperative Oncology Group（ECOG）表现状态≥3 和/或血清碱性磷酸酶≥5×正常值上限（ULN）和/或胆红素≥1.5×ULN 的患者。在 39 例依托泊苷-铂类联合治疗失败的患者中，19 例（49%；12 例女性，中位年龄 53（29-78）岁）接受了 FOLFIRI 方案治疗，中位治疗疗程数为 6（1-16）个。6 例（31%）患者出现至少 1 次 3-4 级毒性（中性粒细胞减少症，n=3；腹泻，n=3），但无毒性死亡。6 例（31%）患者有客观缓解，6 例（31%）患者疾病稳定，7 例（38%）患者肿瘤进展。FOLFIRI 方案治疗的无进展生存期中位数为 4 个月。在不符合条件的患者中，总生存期为 18 个月与 6.8 个月。对于依托泊苷-铂类联合化疗失败后仍状况良好且肝功能正常的 NECs 3 级患者，FOLFIRI 方案是一种安全且潜在有效的二线化疗方案。这些结果需要在未来的前瞻性研究中得到证实。
