Oberg K, Eriksson B
Ludwig Institute for Cancer Research, University Hospital, Uppsala, Sweden.
Acta Oncol. 1989;28(3):425-31. doi: 10.3109/02841868909111217.
Surgery has always been considered to be the primary treatment in patients with neuroendocrine gut and pancreatic tumors, but a significant number of patients present liver metastases already at the first visit. There is obviously a need for effective medical treatment and in the present paper we report our experience of treatment with chemotherapy, the somatostatin analogue SMS 201-995 and interferons. In 30 patients with malignant endocrine pancreatic tumors, chemotherapy including streptozotocin plus 5-fluorouracil had an objective response rate of 63% with a mean duration of the objective response of 17.4 months. There was a difference between clinically functioning and nonfunctioning tumors, which had objective response rates of 68% and 50% and mean response duration of 21 and 9.4 months respectively. The new somatostatin analogue SMS 201-995 was used in 10 patients giving an objective response rate of 40% with a mean duration of 13.5 months. In a series of 22 patients treated with human leukocyte interferon, an objective response rate of 77% was obtained with a mean duration of 8.5 months. A combination of streptozotocin plus 5-fluorouracil gave an objective response rate of 10% with a mean duration of 2.7 months among 31 patients with midgut carcinoid tumors. The somatostatin analogue SMS 201-995, tested in 22 patients with carcinoid tumors, gave an objective response rate of 28% with a mean duration of 18.5 months. Interferon has been tried in three separate studies. The first study, including 36 patients with malignant carcinoid tumors treated with human leukocyte interferon, showed an objective response rate of 47% with a mean duration of 34 months. In a randomized controlled study, where human leukocyte interferon was compared with streptozotocin plus 5-fluorouracil including 10 patients in each arm, no objective response was obtained during the six months' observation in the group of patients receiving chemotherapy, whereas 50% responded in the interferon-treated group. In the third study, IFN-alpha 2b or IntronA was tested in 20 patients with malignant carcinoid tumors and gave an objective response rate of 55% during a six-month observation period. With regard to these data chemotherapy and interferons seem to be equally potent in the treatment of malignant endocrine pancreatic tumors, whereas interferons seem to be superior to both chemotherapy and the somatostatin analogue SMS 201-995 in malignant carcinoid tumors. The somatostatin analogue has proved to be particularly useful in the treatment of patients with severe hormone-related clinical symptoms and in the perioperative period.(ABSTRACT TRUNCATED AT 400 WORDS)
手术一直被视为神经内分泌性肠道和胰腺肿瘤患者的主要治疗方法，但相当多的患者在初诊时就已出现肝转移。显然需要有效的药物治疗，在本文中我们报告了化疗、生长抑素类似物SMS 201 - 995和干扰素的治疗经验。30例恶性内分泌胰腺肿瘤患者接受包括链脲佐菌素加5 - 氟尿嘧啶的化疗，客观缓解率为63%，客观缓解的平均持续时间为17.4个月。有功能和无功能肿瘤之间存在差异，其客观缓解率分别为68%和50%，平均缓解持续时间分别为21个月和9.4个月。10例患者使用了新的生长抑素类似物SMS 201 - 995，客观缓解率为40%，平均持续时间为13.5个月。在一组22例接受人白细胞干扰素治疗的患者中，客观缓解率为77%，平均持续时间为8.5个月。31例中肠类癌肿瘤患者接受链脲佐菌素加5 - 氟尿嘧啶联合治疗，客观缓解率为10%，平均持续时间为2.7个月。在22例类癌肿瘤患者中测试生长抑素类似物SMS 201 - 995，客观缓解率为28%，平均持续时间为18.5个月。干扰素已在三项独立研究中进行了试验。第一项研究包括36例接受人白细胞干扰素治疗的恶性类癌肿瘤患者，客观缓解率为47%，平均持续时间为34个月。在一项随机对照研究中，将人白细胞干扰素与链脲佐菌素加5 - 氟尿嘧啶进行比较，每组10例患者，接受化疗的患者组在6个月观察期内未获得客观缓解，而干扰素治疗组有50%的患者有反应。在第三项研究中，在20例恶性类癌肿瘤患者中测试IFN - α 2b或IntronA，在6个月观察期内客观缓解率为55%。就这些数据而言，化疗和干扰素在治疗恶性内分泌胰腺肿瘤方面似乎同样有效，而在恶性类癌肿瘤中，干扰素似乎优于化疗和生长抑素类似物SMS 201 - 995。生长抑素类似物已被证明在治疗有严重激素相关临床症状的患者以及围手术期特别有用。（摘要截短至400字）
