Northwestern University, Chicago, IL 60208, United States.
Partnership for Health Analytic Research, LLC, Beverly Hills, CA 90212, United States.
World J Gastroenterol. 2017 Sep 7;23(33):6128-6136. doi: 10.3748/wjg.v23.i33.6128.
To describe real-world treatment patterns of gastrointestinal neuroendocrine tumors (GI NET).
In this retrospective cohort study, we used 2009-2014 data from 2 United States commercial claims databases to examine newly pharmacologically treated patients using tabular and graphical techniques. Treatments included somatostatin analogues (SSA), cytotoxic chemotherapy (CC), targeted therapy (TT), interferon (IF) and combinations. We identified patients at least 18 years of age, with ≥ 1 inpatient or ≥ 2 outpatient claims for GI NET who initiated pharmacologic treatment from 7/1/09-6/30/14. A 6 mo clean period prior to first treatment ensured patients were newly treated. Patients were followed until end of enrollment or the study end date, whichever was first.
We identified 2258 newly treated GI NET patients: mean (SD) age was 55.6 years (SD = 9.7), 47.2% of the patients were between 55 and 64 years, and 48.8% were female. All regions of the United States were represented. 59.6% started first-line therapy with SSA monotherapy (964 with octreotide LAR, 380 with octreotide SA, and 1 with lanreotide), 33.3% CC, 3.6% TT, and 0.5% IF. The remainder received combinations. Mean follow up was 576 d. Overall mean first-line therapy duration was 361 d (449 d for SSA, 215 for CC, 267 for TT). 58.9% of patients had no pharmacological treatment beyond first line. The most common second-line was combination therapy with SSA. In graphical pattern analysis, there was no clear pattern visible after first line therapy.
In this study, 60% of patients initiated treatment with SSA alone or in combination. The relatively long time to discontinuation suggests possible sustained effectiveness and tolerability.
描述胃肠神经内分泌肿瘤（GI NET）的真实世界治疗模式。
在这项回顾性队列研究中，我们使用了来自美国两个商业索赔数据库的 2009-2014 年数据，使用表格和图形技术检查了新接受药物治疗的患者。治疗方法包括生长抑素类似物（SSA）、细胞毒性化疗（CC）、靶向治疗（TT）、干扰素（IF）和联合治疗。我们确定了至少 18 岁、至少有 1 次住院或 2 次以上门诊 GI NET 就诊记录且在 2009 年 7 月 1 日至 2014 年 6 月 30 日期间开始药物治疗的患者。在开始首次治疗前 6 个月的清洁期，以确保患者是新接受治疗的。患者随访至入组结束或研究结束日期（以先到者为准）。
我们共确定了 2258 例新接受治疗的 GI NET 患者：平均（SD）年龄为 55.6 岁（SD=9.7），47.2%的患者年龄在 55-64 岁之间，48.8%为女性。美国所有地区均有患者。59.6%的患者开始一线治疗，包括 SSA 单药治疗（964 例奥曲肽 LAR，380 例奥曲肽 SA，1 例兰瑞肽）、33.3%的 CC、3.6%的 TT 和 0.5%的 IF。其余患者接受了联合治疗。平均随访时间为 576 天。总体而言，一线治疗的平均持续时间为 361 天（SSA 为 449 天，CC 为 215 天，TT 为 267 天）。58.9%的患者在一线治疗后没有接受任何药物治疗。最常见的二线治疗是 SSA 联合治疗。在图形模式分析中，一线治疗后没有明显的模式。
在这项研究中，60%的患者单独或联合使用 SSA 开始治疗。停药时间相对较长，提示可能具有持续的有效性和耐受性。
