Bongiovanni Alberto, Recine Federica, Riva Nada, Foca Flavia, Liverani Chiara, Mercatali Laura, Nicolini Silvia, Pieri Federica, Amadori Dino, Ibrahim Toni
Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
Clin Lung Cancer. 2017 Jul;18(4):415-420. doi: 10.1016/j.cllc.2016.11.004. Epub 2016 Nov 21.
Pulmonary carcinoids (PCs) are classed according to the World Health Organization 2004 classification as typical or atypical carcinoids. Owing to their rarity, no dedicated clinical trials with somatostatin analogs (SSAs) have been carried out on primary PCs.
From January 2007 to December 2015, 30 patients with metastatic PCs underwent first-line SSA treatment (20 with octreotide long-acting repeatable 30 mg and 10 with lanreotide 120 mg every 28 days). Eight (23.3%) patients had typical carcinoids and 23 (76.7%) had atypical carcinoids.
The median age was 65.5 years (range, 47-82 years). All patients (23 males and 7 females) were Gallium-68-DOTA-TOC-positron emission tomography/computed tomography (PET/CT)-positive (29 patients) or octreoscan-positive (1 patient). Of the 20 patients who performed fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), 14 (70.0%) were positive and 6 negative (30.0%). The median treatment duration was 10 months (range, 2-59 months). One patient achieved a partial response (3.3%), and 26 (86.6%) showed stable disease. One patient interrupted SSA treatment owing to symptomatic cholelithiasis. Five-year survival was 53.0% (95% confidence interval [CI], 15.0%-80.0%). The median progression-free survival (mPFS) was 11.1 months (95% CI, 7.0-15.0 months). Negative FDG-PET/CT patients had an mPFS of 15.2 months (95% CI, 7.6 months to not reached) compared with 7.0 months (95% CI, 4.0-10.1 months) for FDG-PET/CT-positive patients. No differences in mPFS were found in relation to TTF1-value, histologic subtype, and presence of extrahepatic metastases.
SSAs showed antitumor activity in terms of disease control rate and PFS and proved safe, even in patients with poor Eastern Cooperative Oncology Group status. FDG-PET/CT would appear to be a prognostic factor.
根据世界卫生组织2004年的分类，肺类癌（PCs）分为典型类癌或非典型类癌。由于其罕见性，尚未针对原发性PCs开展过关于生长抑素类似物（SSAs）的专门临床试验。
2007年1月至2015年12月，30例转移性PCs患者接受一线SSA治疗（20例使用长效奥曲肽30mg，10例每28天使用兰瑞肽120mg）。8例（23.3%）患者为典型类癌，23例（76.7%）为非典型类癌。
中位年龄为65.5岁（范围47 - 82岁）。所有患者（23例男性和7例女性）均为镓-68-多胺基多乙酸-酪胺酸-奥曲肽正电子发射断层扫描/计算机断层扫描（PET/CT）阳性（29例患者）或奥曲肽扫描阳性（1例患者）。在20例行氟-18-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）的患者中，14例（70.0%）为阳性，6例为阴性（30.0%）。中位治疗持续时间为10个月（范围2 - 59个月）。1例患者达到部分缓解（3.3%），26例（86.6%）疾病稳定。1例患者因症状性胆石症中断SSA治疗。5年生存率为53.0%（95%置信区间[CI]，15.0% - 80.0%）。中位无进展生存期（mPFS）为11.1个月（95%CI，7.0 - 15.0个月）。FDG-PET/CT阴性患者的mPFS为15.2个月（95%CI，7.6个月至未达到），而FDG-PET/CT阳性患者为7.0个月（95%CI，4.0 - 10.1个月）。在与甲状腺转录因子1（TTF1）值、组织学亚型和肝外转移情况相关的mPFS方面未发现差异。
SSAs在疾病控制率和无进展生存期方面显示出抗肿瘤活性，并且即使在东部肿瘤协作组状态较差的患者中也证明是安全的。FDG-PET/CT似乎是一个预后因素。
