ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2017) 52 P15 | DOI: 10.1530/endoabs.52.P15

Platinum-etoposide chemotherapy for extra-pulmonary high grade neuroendocrine carcinoma (EP-G3-NEC): A survey of clinical practice

Angela Lamarca1, Melissa Frizziero1, Jorge Barriuso1,2, Mairéad G McNamara1,2, Richard A Hubner1 & Juan W Valle1,2

1The Christie NHS Foundation Trust, Manchester, UK; 2University of Manchester, Manchester, UK.

Introduction: Platinum-etoposide chemotherapy is a globally established chemotherapy combination for EP-G3-NEC. However, there are many different schedules for such chemotherapy, and the preferred one for EP-G3-NEC has not been established.

Methods: An international survey was created, and completed by colleagues with an expertise in the field of neuroendocrine neoplasms. The aim was to explore which schedules of platinum-etoposide chemotherapy are used across centres and to assess consistency in clinical practice.

Results: Sixty four replies were received (June-August’17); completed by medical oncologists (43;67.2%), clinical oncologists (11;17.2%), gastroenterologists (8;12.5%) and endocrinologists (2;3.1%). United Kingdom was the most represented country (25;39.1%), followed by Spain (13;20.3%). Most of the physicians completing the survey (39;60.9%) had >10 years of experience in the field; 29 (46.0%) were working in European Neuroendocrine Tumor Society (ENETS) Centres of Excellence (CoE). A small minority did not take Ki67 (7;11.1%) or morphology (7;10.9%) into consideration when selecting type of chemotherapy to be administered. Regarding choice of chemotherapy, most (61;95.3%) agreed on selecting platinum-etoposide chemotherapy as first-line treatment for NEC tumours ± poor-differentiation ± Ki67>55%, although there was a large number of different schedules used: cisplatin-based (28/60;46.7%), carboplatin-based (32/60;53.3%). Most centres chose a schedule with intravenous etoposide (53/60;88.3%), while oral etoposide was less popular (7/60;11.7%). Chemotherapy was usually administered up to a maximum of 6 cycles (49;79.0%). At time of progression, choice of second-line chemotherapy was influenced by the time between completion of first-line chemotherapy and tumour progression. When this period was >6 months, re-challenge with platinum-etoposide was the preferred choice (29;46.0%). Conversely, when time to progression was <6 months, platinum-etoposide was not considered by any of the physicians as an option for second-line chemotherapy (0%), and alternative combinations such as fluoropyrimidine/irinotecan (21;34.4%) and temozolomide/capecitabine (18; 29.5%) were preferred.

Conclusions: Although there appears to be consensus in selection of platinum-etoposide based chemotherapy for first-line treatment for patients with advanced EP-G3-NEC, significant variation in the exact regimen employed across different institutions exists. Prospective studies in this patient population are required in order to standardise practice.

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