Thoracic Oncology Unit, Institut Jules Bordet, Hôpitaux Universitaires de Bruxelles, Université Libre de Bruxelles, Bruxelles, Belgium.
Thoracic Oncology Unit, Pneumology department, Hôpital Erasme, Hôpitaux Universitaires de Bruxelles, Université Libre de Bruxelles, Bruxelles, Belgium.
Lung Cancer. 2023 Jul;181:107232. doi: 10.1016/j.lungcan.2023.107232. Epub 2023 May 10.
Neuroendocrine lung cancer constitutes a continuum from carcinoid tumours (CT) to large cell neuroendocrine (LCNEC) and small-cell carcinomas (SCLC). Except for SCLC, there is no consensual agreement on systemic therapy. The aim of this study is to review our clinical experience among patients with CT and LCNEC in the light of a systematic review of the literature.
A retrospective study of all patients with CT and LCNEC receiving a systemic therapy at Institut Jules Bordet and Erasme Hospital between 01/01/2000-31/12/2020. A systematic review of the literature was performed in Ovid Medline.
53 patients (21 CT and 32 LCNEC) were included. Despite limited response rates, patients with CT receiving a "carcinoid-like" 1st-line regimen (somatostatin analogues (SSA), everolimus, peptide receptor radionuclide therapy (PRRT)) had a numerically longer survival compared to those receiving other type of regimens (median 51.4 vs 18.6 months, respectively; p = 0.17). We observed a similar survival between 1st line "SCLC-like" vs "non-small cell lung cancer (NSCLC)-like" schemes in LCNEC (median 11.2 vs 12.6 months, respectively; p = 0.46). The systematic review identified 23 studies (12 prospective, 15 and 8 for CT and LCNEC respectively). For CT, everolimus and SSA led to prolonged disease control with an acceptable toxicity profile, while higher response rates but lower tolerance were associated with PRRT and chemotherapy regimens including oxaliplatine and dacarbazine. For LCNEC, no difference emerged when comparing "SCLC-like" and "NSCLC-like" regimens considering response rate, progression-free or overall survival.
SSA, everolimus and PRRT present a good therapeutic index for CT, while the role of chemotherapy remains limited to aggressive and rapidly evolving CT. The best type of chemotherapy regimen remains an open question in LCNEC.
神经内分泌肺癌是从类癌肿瘤（CT）到大细胞神经内分泌（LCNEC）和小细胞癌（SCLC）的连续体。除了 SCLC 之外，对于其他类型的肺癌，尚无共识的系统治疗方案。本研究旨在根据文献的系统综述，回顾我院 CT 和 LCNEC 患者的临床经验。
对 2000 年 1 月 1 日至 2020 年 12 月 31 日在 Jules Bordet 研究所和 Erasme 医院接受系统治疗的所有 CT 和 LCNEC 患者进行回顾性研究。在 Ovid Medline 上进行了文献的系统综述。
共纳入 53 例患者（21 例 CT 和 32 例 LCNEC）。尽管反应率有限，但接受“类癌样”一线方案（生长抑素类似物（SSA）、依维莫司、肽受体放射性核素治疗（PRRT））治疗的 CT 患者的生存时间明显长于接受其他类型方案治疗的患者（中位生存时间分别为 51.4 个月和 18.6 个月，p=0.17）。我们观察到 LCNEC 中一线“SCLC 样”方案与“非小细胞肺癌（NSCLC）样”方案之间的生存情况相似（中位生存时间分别为 11.2 个月和 12.6 个月，p=0.46）。系统综述共纳入 23 项研究（12 项前瞻性研究，分别有 15 项和 8 项针对 CT 和 LCNEC）。对于 CT，依维莫司和 SSA 可延长疾病控制时间，且具有可接受的毒性特征，而 PRRT 和包括奥沙利铂和达卡巴嗪在内的化疗方案则具有更高的缓解率和更低的耐受性。对于 LCNEC，比较“SCLC 样”和“NSCLC 样”方案时，反应率、无进展生存期或总生存期均无差异。
SSA、依维莫司和 PRRT 对 CT 具有较好的治疗指数，而化疗的作用仍然局限于侵袭性和快速进展的 CT。在 LCNEC 中，哪种类型的化疗方案最佳仍然是一个悬而未决的问题。
