Using chemotherapy against metastatic pancreatic neuroendocrine neoplasm: how aggressively do we treat it? Real world data from a Brazilian Cancer Center

• Published in: Brazilian Journal of Oncology Vol. 18
• Main Authors: Donadio, Mauro Daniel Spina, Jesus, Victor Hugo Fonseca de, Barros, Milton José
• Format: Journal Article
• Language: English
• Published: Sociedade Brasileira de Oncologia Clínica, Sociedade Brasileira de Cirurgia Clínica and Sociedade Brasileira de Radioterapia 01-10-2022
• Subjects: drug therapy; neuroendocrine tumors; pancreatic neoplasms
• ISSN: 2526-8732; 2526-8732
• DOI: 10.5935/2526-8732.20220285

Introduction: Pancreatic neuroendocrine neoplasms (pNEN) have poor prognosis. Available treatment options are limited. We aimed to evaluate the clinical characteristics and outcomes in patients with pNEN undergoing systemic chemotherapy. Methods: Retrospective study of patients with metastatic pNEN diagnosed between January 2000 and April 2018 in A.C. Camargo Cancer Center. We evaluated epidemiological characteristics and outcomes of patients who received systemic chemotherapy between the first and third-lines. Results: 35 patients with median age of 54.4 years; 51.4% had diabetes mellitus and 62.9% had smoking history. Most primary tumors were located in pancreatic body or tail and 34.3% were described as well or moderately differentiated, 40% were of high grade. Overall, chemotherapy from first to third-line was prescribed 50 times, 62% consisted of platin doublet, the chosen schema 50% of times when Ki-67<20%, 55.5% for Ki-67 between 20% and 55% and 66.7% for Ki-67>55%. The median PFS and RR were 7.8 months and 40.7%; 13 months and 33.3% and 3 months and 0% in the first, second and third-line, respectively. The estimated OS was 53.4 months. We found that female (HR 2.8, p=0.034), DM (HR 4.5, p=0.004), smoking (HR 3.5, p=0.017), high grade tumors (HR 3.8, p=0.025) and tumors localized in head/ neck of the pancreas (HR 7.1, p<0.001) were negative prognostic factors for OS in univariate analysis. Conclusion: Our real world data shows that doublet platin is a preferred and active schema for treating pNEN, especially in first and second line. It brings the greatest benefit for undifferentiated tumors. Nevertheless, the prognosis remains poor and some factors may contribute to worse outcomes, such as female gender, silent tumors that do not manifest DM, poorly differentiated tumours, smoking and location in the head and neck of the pancreas.