Department of Medical Oncology, BC Cancer, 600 West 10th Avenue, Vancouver, BC, V5Z4E6, Canada.
Department of Oncology, Tom Baker Cancer Centre, University of Calgary, 1331 29 St NW, Calgary, AB, T2N 4N2, Canada.
Med Oncol. 2018 Aug 4;35(9):123. doi: 10.1007/s12032-018-1189-1.
Gastroenteropancreatic (GEP) neuroendocrine tumors (NETs) represent a heterogeneous group of tumors that is associated with an indolent course. Octreotide has a positive effect on disease stabilization in well-differentiated midgut NETs, but a meaningful survival analysis was not possible due to insufficient events. Higher doses of octreotide long-acting release (LAR) are often used in clinical practice for control of carcinoid symptoms and our objective was to determine if dose of octreotide correlates with survival. We reviewed all patients with advanced GEP NETs who initiated treatment with octreotide LAR between 2000 and 2013 in a large, representative Canadian province. We compared overall survival in patients who received low (< 30 mg) compared to high (≥ 30 mg) doses of octreotide. A total of 170 patients were identified. Baseline characteristics in the low- and high-dose groups were similar: median age 62/63 years, 50/58% were male, 46/48% originated from the small bowel, and 74/66% had liver metastases at diagnosis. The median time from diagnosis to treatment initiation was 5.5 and 6.0 months. Octreotide LAR was initiated with the intent of symptom management (71%), disease stabilization (23%), or biomarker control (6%). Median overall survival (OS) was better in the high-dose group, 66 months compared to 22 months (multivariate HR 0.5, p < 0.01). Age ≥ 65 (HR 1.9, p < 0.01), ECOG ≥ 2 (HR 2.7, p < 0.01), and pancreatic NETs (HR 1.7, p = 0.03) were all predictors of worse survival. Our findings suggest that octreotide may confer survival benefits in GEP NETs. Further prospective studies are warranted to validate the impact of high-dose octreotide on outcomes.
胃肠胰神经内分泌肿瘤（GEP-NETs）是一组异质性肿瘤，其病程呈惰性。奥曲肽对分化良好的中肠 NETs 的疾病稳定有积极作用，但由于事件不足，无法进行有意义的生存分析。在临床实践中，常使用更高剂量的奥曲肽长效释放（LAR）来控制类癌症状，我们的目的是确定奥曲肽的剂量是否与生存相关。我们回顾了 2000 年至 2013 年间在加拿大一个大的代表性省份开始用奥曲肽 LAR 治疗的晚期 GEP-NETs 患者。我们比较了接受低（<30mg）与高（≥30mg）剂量奥曲肽治疗的患者的总生存率。共确定了 170 名患者。低剂量和高剂量组的基线特征相似：中位年龄 62/63 岁，50/58%为男性，46/48%起源于小肠，74/66%在诊断时已有肝转移。从诊断到开始治疗的中位时间为 5.5 和 6.0 个月。奥曲肽 LAR 的起始目的是为了控制症状（71%）、稳定疾病（23%）或控制生物标志物（6%）。高剂量组的中位总生存期（OS）更好，为 66 个月，而低剂量组为 22 个月（多变量 HR 0.5，p<0.01）。年龄≥65 岁（HR 1.9，p<0.01）、ECOG≥2（HR 2.7，p<0.01）和胰腺 NETs（HR 1.7，p=0.03）都是生存较差的预测因素。我们的发现表明，奥曲肽可能对 GEP-NETs 有生存获益。需要进一步的前瞻性研究来验证高剂量奥曲肽对结局的影响。
