Chemotherapy with 5-fluorouracil, cisplatin and streptozocin for neuroendocrine tumours

• Published in: British journal of cancer Vol. 102; no. 7; pp. 1106 - 1112
• Main Authors: Turner, N C, Strauss, S J, Sarker, D, Gillmore, R, Kirkwood, A, Hackshaw, A, Papadopoulou, A, Bell, J, Kayani, I, Toumpanakis, C, Grillo, F, Mayer, A, Hochhauser, D, Begent, R H, Caplin, M E, Meyer, T
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 30-03-2010; Nature Publishing Group
• Subjects: 631/92/436/108; 692/699/67/1459/1963; 692/700/565/1436/1437; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - standards; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Cancer Research; Cisplatin - administration & dosage; Cisplatin - adverse effects; Cisplatin - therapeutic use; Clinical Study; Drug Resistance; Epidemiology; Female; Fluorouracil - administration & dosage; Fluorouracil - adverse effects; Fluorouracil - therapeutic use; Humans; Male; Medical sciences; Middle Aged; Molecular Medicine; Neuroendocrine Tumors - drug therapy; Neuroendocrine Tumors - mortality; Oncology; Streptozocin - administration & dosage; Streptozocin - adverse effects; Streptozocin - therapeutic use; Survival Analysis; Treatment Outcome; Tumors; Young Adult; Ki-67; NETs; mitotic index; chemotherapy; Antineoplastic agent; Enzyme; Fluoropyrimidine derivatives; Transferases; Enzyme inhibitor; Biological marker; Thymidylate synthase; Cisplatin; Alkylating agent; Chemotherapy; Mitotic index; Treatment; Cancerology; Antimetabolic; Methyltransferases; Ki67 antigen; Pyrimidine derivatives; Neuroendocrine tumor; Platinum II Complexes; Fluorouracil
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/sj.bjc.6605618

Background:
The role of chemotherapy for neuroendocrine tumours remains controversial and there is no standard regimen.
Method:
We report the outcome for a consecutive series of chemonaive patients with metastatic or locally advanced neuroendocrine tumours treated with a combination of 5-fluorouracil (500 mg m
−2
), cisplatin (70 mg m
−2
) and streptozocin (1000 mg m
−2
) (FCiSt) administered three weekly for up to six cycles. Patients were assessed for radiological response, toxicity and survival.
Results:
In the 79 patients assessable for response, treatment with FCiSt was associated with an overall response rate of 33% (38% for pancreatic primary sites and 25% for non-pancreatic primary sites). Stable disease occurred in a further 51%, with progression in 16%. The median time to progression was 9.1 months and median overall survival was 31.5 months. The most common grade 3–4 toxicity was neutropaenia (28% patients) but grade 3–4 infection was rare (7%). The most frequent non-haematological grade 3–4 toxicity was nausea and vomiting (17%). Prognostic factors included Ki-67, mitotic index, grade and chromogranin A, whereas response to chemotherapy was predicted by mitotic index, grade and
α
-fetoprotein.
Conclusions:
FCiSt is an effective regimen for neuroendocrine tumours with an acceptable toxicity profile. Grade and mitotic index are the best predictors of response.