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Extended cycle streptozotocin/5-FU chemotherapy for maintenance therapy in pancreatic neuroendocrine tumors

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Abstract

Purpose

The standard of care treatment for patients with advanced pancreatic neuroendocrine tumors (pNET) is a combination of streptozotocin and 5-FU. Although widely used, little is known about the best long-term strategy with these substances.

Methods

We here report our experience of 28 patients treated with streptozotocin/5-FU for advanced pNET with special consideration for long-term management using an extended cycle protocol.

Results

Standard 6-weekly Moertel protocol resulted in a median progression-free survival of 21 months (range 3–128) and a median overall survival of 69 months (range 3–157+) in the whole cohort. Thirteen of the 28 patients were switched to an extended 3-month cycle protocol for maintenance therapy. Of these 13 patients, 2 achieved complete remission, 1 partial remission, and 8 stable disease as best response while 2 showed progressive disease following switch to the extended protocol, resulting in an additional median progression-free survival of 23 months. Median overall survival after the start of chemotherapy in this patient group was 69 months (21–157+). Patients benefitted from extended periods free of chemotherapy-associated side effects after switching to the extended cycle protocol.

Conclusions

Switching to an extended cycle protocol of 3 months for maintenance therapy following initial standard cycles may achieve long-term disease stabilization in selected patients with advanced pNET with good patient acceptance.

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Funding

This study was not funded by external sources.

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Authors and Affiliations

  1. Department of Medicine – Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Joerg Schrader, Michael Blaeker, Katharina Zimmermann-Fraedrich, Andrea Pace, Ansgar W. Lohse & Daniel Benten

  2. Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Joerg Schrader, Daniel Perez & Jakob R. Izbicki

  3. Department for Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Frank O. Henes

Authors
  1. Joerg Schrader
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  2. Frank O. Henes
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  3. Michael Blaeker
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  4. Katharina Zimmermann-Fraedrich
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  5. Andrea Pace
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  8. Ansgar W. Lohse
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Corresponding author

Correspondence to Joerg Schrader.

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Conflict of interest

J.S. and D.B. received travel assistance, speaker honoraria, and research funding from Novartis and IPSEN. The remaining authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The local ethics committee approved retrospective collection and analysis of patient data without written informed consent from patients (Ärztekammer Hamburg, WF-023/13). A written informed consent of patients was not deemed necessary due to anonymous data analysis performed in accordance with local governmental guidelines. This article does not contain any studies with animals performed by any of the authors.

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Schrader, J., Henes, F.O., Blaeker, M. et al. Extended cycle streptozotocin/5-FU chemotherapy for maintenance therapy in pancreatic neuroendocrine tumors. Endocrine 65, 460–467 (2019). https://doi.org/10.1007/s12020-019-01941-w

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  • DOI: https://doi.org/10.1007/s12020-019-01941-w

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