a Affiliated Hospital of Qinghai University , Xining , China.
b Department of Medical Oncology , National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China.
Expert Opin Pharmacother. 2018 Jun;19(8):795-807. doi: 10.1080/14656566.2018.1465928. Epub 2018 Apr 25.
Patients with advanced well-differentiated neuroendocrine tumors (NETs) who have bulky and/or symptomatic and/or rapidly progressive disease require chemotherapy treatment.
This review summarizes the accumulating evidence for treatment with fluorouracil-based chemotherapy in well-differentiated NETs. The main clinical studies, toxicity and predictors of fluorouracil- based chemotherapy regimens in well-differentiated NETs are discussed, along with the current issues, future research directions and therapeutic prospects.
Somatostatin analogs may control symptoms of hormone excess and tumor growth in patients with well-differentiated metastatic NETs, and biological therapies may improve progression-free survival for these patients. However, chemotherapy leads to higher objective response rates and symptom control by reducing tumor bulk. The low response rate and significant toxicities of conventional chemotherapy regimens limit their widespread use. Fortunately, some novel fluoropyrimidine-based treatment including fluorouracil, capecitabine, or S-1 based chemotherapy with or without antiangiogenic agents have been investigated in recent years. These treatments showed significant efficacy and less toxicity in pancreatic and non-pancreatic metastatic well-differentiated NETs. Additionally, non-pancreatic well-differentiated NETs have also achieved similar tumor response or survival comparable to pancreatic NETs. Moreover, some predictors of response to these treatment regimens have been evaluated.
有大量且/或有症状和/或快速进展的晚期分化良好的神经内分泌肿瘤（NET）患者需要化疗。
本文综述了氟尿嘧啶为基础的化疗治疗分化良好的 NET 的累积证据。讨论了氟尿嘧啶为基础的化疗方案在分化良好的 NET 中的主要临床研究、毒性和预测因素，以及当前的问题、未来的研究方向和治疗前景。
生长抑素类似物可控制分化良好的转移性 NET 患者激素过度和肿瘤生长的症状，生物疗法可改善这些患者的无进展生存期。然而，化疗通过减少肿瘤体积，可导致更高的客观缓解率和症状控制。传统化疗方案的低反应率和显著毒性限制了其广泛应用。幸运的是，近年来已研究了一些新型氟嘧啶类治疗药物，包括氟尿嘧啶、卡培他滨或 S-1 联合或不联合抗血管生成药物的化疗。这些治疗方法在胰腺和非胰腺转移性分化良好的 NET 中显示出显著的疗效和较少的毒性。此外，非胰腺分化良好的 NET 也取得了与胰腺 NET 相当的肿瘤反应或生存。此外，还评估了这些治疗方案的一些反应预测因素。
