title: Systemic treatment in unresectable metastatic well-differentiated carcinoid tumors: consensus results from a modified delphi process.
abstract: OBJECTIVE
  This study aimed to develop expert consensus for the use of systemic treatments for unresectable metastatic well-differentiated (grade 1-2) carcinoid tumors using the RAND/UCLA modified Delphi process.
  
  
  METHODS
  After a comprehensive literature review, 404 patient scenarios addressing the use of systemic treatments for carcinoid tumors were constructed. A multidisciplinary panel of 10 physicians assessed the scenarios as appropriate, inappropriate, or uncertain (on a 1-9 scale) or as an area of disagreement before and after an extended discussion of the evidence.
  
  
  RESULTS
  Experts were medical and surgical oncologists, interventional radiologists, and gastroenterologists. Among rated scenarios, disagreement decreased from 14% before the meeting to 4% after. Consensus statements about midgut carcinoids included the following: (1) Somatostatin analogs are appropriate as first-line therapy for all patients; (2) In patients with uncontrolled secretory symptoms, it is appropriate to increase the dose/frequency of octreotide long-acting repeatable up to 60 mg every 4 weeks or up to 40 mg every 3 weeks as second-line therapy for refractory carcinoid syndrome. Other options may also be appropriate. Consensus was similar for non-midgut carcinoids.
  
  
  CONCLUSIONS
  The Delphi process provided a structured methodological approach to assist clinician experts in reaching consensus on the appropriateness of specific medical therapies for the treatment of advanced carcinoid tumors.
authors.affiliation: Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Strosberg
authors.forename: George A
authors.initials: GA
authors.lastname: Fisher
authors.forename: Al B
authors.initials: AB
authors.lastname: Benson
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Malin
authors.forename: Dasha
authors.initials: D
authors.lastname: Cherepanov
authors.forename: Michael S
authors.initials: MS
authors.lastname: Broder
authors.forename: Lowell B
authors.initials: LB
authors.lastname: Anthony
authors.forename: Bulent
authors.initials: B
authors.lastname: Arslan
authors.forename: George A
authors.initials: GA
authors.lastname: Fisher
authors.forename: John F
authors.initials: JF
authors.lastname: Gibbs
authors.forename: Edward
authors.initials: E
authors.lastname: Greeno
authors.forename: Renuka V
authors.initials: RV
authors.lastname: Iyer
authors.forename: Michelle K
authors.initials: MK
authors.lastname: Kim
authors.forename: William
authors.initials: W
authors.lastname: Maples
authors.forename: Philip A
authors.initials: PA
authors.lastname: Philip
authors.forename: Jonathan
authors.initials: J
authors.lastname: Strosberg
authors.forename: Edward M
authors.initials: EM
authors.lastname: Wolin
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002276:Carcinoid Tumor / Q000188:drug therapy* / Q000473:pathology; D032921:Consensus; D003697:Delphi Technique; D004334:Drug Administration Schedule; D005104:Expert Testimony; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D009362:Neoplasm Metastasis; D015282:Octreotide / Q000008:administration & dosage; D010456:Peptides, Cyclic / Q000008:administration & dosage; D015203:Reproducibility of Results; D013004:Somatostatin / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D010456:Peptides, Cyclic; C060347:lanreotide; D013004:Somatostatin; D015282:Octreotide