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-August17); 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.
04 Dec 2017
UK and Ireland Neuroendocrine Tumour Society