Singh S, Sivajohanathan D, Asmis T, Cho C, Hammad N, Law C, Wong R, Zbuk K
Division of Medical Oncology and Hematology, Odette Cancer Centre, Toronto.
Department of Oncology, McMaster University, and Program in Evidence-Based Care, Cancer Care Ontario, Hamilton.
Curr Oncol. 2017 Aug;24(4):249-255. doi: 10.3747/co.24.3634. Epub 2017 Aug 31.
The purpose of the present review was to determine which antineoplastic systemic therapy is most effective in improving clinical outcomes for patients with incurable gastroenteropancreatic neuroendocrine tumours (nets).
A systematic search (2008-2016) of the literature in the medline and embase databases and the Cochrane Database of Systematic Reviews was conducted; abstracts from the American Society of Clinical Oncology, the American Society of Clinical Oncology Gastrointestinal Cancers Symposium, the European Society for Medical Oncology, the European Cancer Congress, the European Neuroendocrine Tumor Society, and the North American Neuroendocrine Tumor Society were reviewed. Draft recommendations were created, and a comprehensive review process was undertaken. Outcomes-including progression-free survival (pfs), overall survival, objective response rate, adverse events, and quality of life-were extracted from each of the studies.
Eleven randomized controlled trials (rcts), sixteen nonrandomized prospective studies, and thirteen retrospective studies met the inclusion criteria.
Patients with well-or moderately-differentiated pancreatic nets (pnets) should receive targeted therapy (that is, everolimus or sunitinib), and patients with non-pnets should be offered either targeted therapy (that is, everolimus) or somatostatin analogues (ssas-that is, octreotide long-acting release or lanreotide). Evidence from two phase iii trials demonstrated a significant pfs benefit for patients with pnets. For patients with non-pnets, the evidence comes from subgroup analyses of rcts, as well as from a planned interim analysis. Although the evidence has limitations, the rarity of the disease, coupled with the difficulty of conducting methodologically sound trials in the affected population, means that treatment decisions have to make use of the best available evidence. Because of insufficient evidence for both pnets and non-pnets, no evidence-based recommendation can be made for or against other types of targeted therapy, other ssas, chemotherapy, or combination therapy.
本综述的目的是确定哪种抗肿瘤全身治疗对无法治愈的胃肠胰神经内分泌肿瘤（NETs）患者改善临床结局最为有效。
对Medline和Embase数据库以及Cochrane系统评价数据库进行了系统检索（2008 - 2016年）；对美国临床肿瘤学会、美国临床肿瘤学会胃肠道癌症研讨会、欧洲医学肿瘤学会、欧洲癌症大会、欧洲神经内分泌肿瘤学会和北美神经内分泌肿瘤学会的摘要进行了回顾。制定了初步建议，并进行了全面的综述过程。从每项研究中提取了包括无进展生存期（PFS）、总生存期、客观缓解率、不良事件和生活质量等结局。
11项随机对照试验（RCTs）、16项非随机前瞻性研究和13项回顾性研究符合纳入标准。
高分化或中分化胰腺神经内分泌肿瘤（pNETs）患者应接受靶向治疗（即依维莫司或舒尼替尼），非pNETs患者应接受靶向治疗（即依维莫司）或生长抑素类似物（SSAs，即长效奥曲肽或兰瑞肽）。两项III期试验的证据表明pNETs患者的PFS有显著获益。对于非pNETs患者，证据来自RCTs的亚组分析以及计划中的中期分析。尽管证据存在局限性，但该疾病的罕见性，加上在受影响人群中进行方法学上合理试验的难度，意味着治疗决策必须利用现有的最佳证据。由于pNETs和非pNETs的证据都不足，因此无法基于证据对其他类型的靶向治疗、其他SSAs、化疗或联合治疗提出支持或反对的建议。
