Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, Rozzano Milan, Italy.
Department of Pathology, Charité Mitte.
Pancreas. 2020 Aug;49(7):912-917. doi: 10.1097/MPA.0000000000001593.
The objective of this study was to investigate the efficacy and tolerability of 5-fluorouracil-oxaliplatin (FOLFOX) in advanced gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs).
Retrospective analysis of consecutive 72 advanced GEP-NENs treated with FOLFOX between 2005 and 2016 at a single German referral center for NENs was performed. We assessed treatment response by response evaluation criteria in solid tumors 1.0 criteria, progression-free survival by Kaplan-Meyer method, and risk factor analysis by Cox-regression model.
Patients were 44.5% G1/G2, 55.5% G3, receiving a median of 7 treatment cycles (range, 2-21), and had a median of 18 months of follow-up (range, 3-111 months). Disease control was achieved in 75.0% of cases but 91.3% in the 23 patients receiving FOLFOX as first line (P = 0.04). Median progression-free survival of the overall population was 8 months. A better outcome was significantly related to treatment duration (P = 0.02) and grade of histological differentiation for G3 patients (well differentiated vs poorly differentiated, P = 0.03). Adverse events occurred in 88.8% of patients, mostly grade 1 and 2 hematotoxicity and chemotherapy-induced peripheral sensory neuropathy (84.1% and 50.0% of patients, respectively).
Our results support FOLFOX as therapeutic option in advanced GEP-NENs with poor prognosis, either at first or further therapy line. Longer duration of therapy was associated with a more durable benefit.
本研究旨在探讨氟尿嘧啶-奥沙利铂（FOLFOX）治疗晚期胃肠胰神经内分泌肿瘤（GEP-NENs）的疗效和耐受性。
对 2005 年至 2016 年期间在德国一家神经内分泌肿瘤转诊中心接受 FOLFOX 治疗的 72 例晚期 GEP-NENs 患者进行回顾性分析。我们根据实体瘤反应评价标准 1.0 标准评估治疗反应、采用 Kaplan-Meier 方法评估无进展生存期、采用 Cox 回归模型进行风险因素分析。
患者的组织学分级中，G1/G2 占 44.5%，G3 占 55.5%，接受中位数为 7 个周期（范围为 2-21 个）的治疗，中位随访时间为 18 个月（范围为 3-111 个月）。75.0%的病例达到疾病控制，但在接受 FOLFOX 一线治疗的 23 例患者中，这一比例为 91.3%（P = 0.04）。总体人群的中位无进展生存期为 8 个月。更好的预后与治疗持续时间（P = 0.02）和 G3 患者的组织学分化程度（高分化与低分化，P = 0.03）显著相关。88.8%的患者发生了不良反应，主要为 1 级和 2 级血液毒性和化疗引起的周围感觉神经病变（分别为 84.1%和 50.0%的患者）。
我们的结果支持 FOLFOX 作为预后不良的晚期 GEP-NENs 的治疗选择，无论是一线还是进一步的治疗线。治疗持续时间较长与更持久的获益相关。
