title: Doxorubicin and streptozotocin after failed biotherapy of neuroendocrine tumors.
abstract: BACKGROUND
  Well-differentiated neuroendocrine tumors are treated primarily with somatostatin analogs and interferon-alpha. It is not clear what therapy should be applied after failed biotherapy. Our aim was to establish whether patients whose tumors rapidly progress under biotherapy may benefit from chemotherapy.
  
  
  METHODS
  In 10 patients with metastatic neuroendocrine tumors (4 foregut, 3 midgut, 1 retroperitoneal, and 2 of unknown origin) streptozotocin and doxorubicin were used as second-line or third-line therapy. Tumor response was assessed by computed tomography of the abdomen and thorax and measurement of tumor secretion products (serum chromogranin A, urinary 5-hydroxyindoleacetic acid).
  
  
  RESULTS
  Three patients showed a radiological response over a mean time of 30 mo (range: 7-67 mo). Median survival after initiation of chemotherapy was 50 mo in patients with a response and 8 mo in non-responders. Three patients developed major side effects (nephrotoxicity, diabetes, and encephalopathy).
  
  
  CONCLUSIONS
  Streptozotocin and doxorubicin produce poor response rates in patients with progressive neuroendocrine tumors after failed biotherapy, but may prolong life in those patients who show a tumor response.
authors.affiliation: Department of Medicine I, University of Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany. marianne.pavel@med1.imed.uni-erlangen.de
authors.forename: Marianne E
authors.initials: ME
authors.lastname: Pavel
authors.forename: Ulrich
authors.initials: U
authors.lastname: Baum
authors.forename: Eckhart G
authors.initials: EG
authors.lastname: Hahn
authors.forename: Johannes
authors.initials: J
authors.lastname: Hensen
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D018450:Disease Progression; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D018358:Neuroendocrine Tumors / Q000188:drug therapy* / Q000473:pathology; D013311:Streptozocin / Q000008:administration & dosage; D016019:Survival Analysis
chemical_list: D013311:Streptozocin; D004317:Doxorubicin