Chemotherapy may benefit advanced pulmonary carcinoid tumour patients

By Laura Cowen, medwireNews Reporter

A review of patients with advanced pulmonary carcinoid tumours shows that they can be responsive to chemotherapy.

Pulmonary carcinoid tumours are relatively rare, comprising approximately 2% of all primary lung cancers. Few data therefore exist on the optimal management of patients diagnosed with these tumours, explain Bruce Johnson (Dana-Farber Cancer Institute, Boston, Massachusetts, USA) and colleagues.

By reviewing the medical records of 300 patients with locally advanced and metastatic pulmonary carcinoid tumours (220 typical, 80 atypical), Johnson and team hoped to better define the role of chemotherapy and adjuvant treatment in the management of this disease.

The majority of patients, who were all treated between 1990 and 2012, presented with early stage (IA or IB) disease, but metastatic presentation was over three times more common with atypical than typical carcinoids, at 20% versus 6%.

The risk of recurrence was higher for resected atypical than for typical carcinoids, with 26 (41%) of 64 resected atypical patients experiencing disease recurrence at a median of 3.7 years after surgery compared with just three (1%) patients with resected typical carcinoid, who experienced a recurrence at 8, 9 and 12 years.

No patient with a metastatic typical carcinoid tumour died during the study period, whereas the 5-year survival rate was 24% for patients with metastatic atypical carcinoid tumours and the median survival time was 3.3 years.

A total of 39 patients (35 atypical) were treated with 76 chemotherapy regimens that were grouped into five categories: etoposide-based (13 patients), temozolomide-based (14 patients), other cytotoxic treatments (eight patients), octreotide-based (15 patients) and clinical trials (seven patients).

The response rate (RR) for etoposide plus platinum-based therapy was 23%, with a median progression-free survival (PFS) of 7 months and a disease-control rate (DCR) of 69%. For temozolomide-based treatments the respective values were 14%, 10 months and 57%.

Octreotide-based therapies also showed efficacy, with a 10% RR, 15-month PFS and 70% DCR observed. Furthermore, eight of 10 patients with octreotide-avid disease treated with an octreotide-based regimen experienced disease control (one partial response, seven stable disease) for a median of 18 months.

The researchers also identified seven patients (six atypical) who were treated with adjuvant platinum–etoposide chemoradiation. At the time of the study, two patients had developed a metastatic recurrence at 2.1 and 4.6 years, while the remaining five were free from recurrence after a median of 14 months.

Writing in Lung Cancer, Johnson and co-authors conclude that although their results “support previous findings that a subset of pulmonary carcinoid tumors are responsive to chemotherapy”, larger studies are needed “to determine the optimal therapy for patients with metastatic disease.”

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