title: Not All Patients with a Pancreatic Neuroendocrine Tumour Will Benefit from All Approved or Recommended Therapeutic Options: A Real-Life Retrospective Study.
abstract: BACKGROUND
  At least nine therapeutic options are recommended or approved for pancreatic neuroendocrine tumour (pNET). The primary endpoint of this study was to determine the number of therapeutic lines given before death. Secondary endpoints were to determine toxic events as a function of number of therapeutic lines and of time.
  
  
  METHODS
  Patients with pNET treated between 1998 and 2010 at our centre were characterised. All therapeutic lines were recorded as well as tumour- or toxic-related deaths. Persistent treatment-related toxicity (PTRT) was defined as: chronic kidney disease, anaemia, thrombocytopenia, neutropenia, severe liver failure, cardiac failure and recurrent sepsis, precluding at least one other therapeutic option or second cancers.
  
  
  RESULTS
  Ninety-two patients were analysed. The median follow-up was 7 years. The 1-, 2- and 5-year overall survival rates were 90, 81 and 51%, respectively. After 3 and 5 therapeutic lines, 23 and 50% of patients had died, respectively. After 3 and 5 lines, the frequency of toxic events was 8 and 24%, respectively. Overall, 17 toxic events were observed including 6 treatment-related deaths and 11 PTRT. After 1, 2 and 5 years of treatment, the frequency of toxic events was 6, 9 and 16%, respectively.
  
  
  CONCLUSIONS
  Tumour- and toxic-related deaths as well as PTRT may preclude access to all therapeutic options in patients with pNET. Optimised risk benefit sequence should be investigated.
authors.affiliation: Department of Nuclear Medicine and Endocrine Tumours, Gustave Roussy, Université Paris XI, Villejuif, France.
authors.forename: Amandine
authors.initials: A
authors.lastname: Berdelou
authors.forename: Valérie
authors.initials: V
authors.lastname: Boige
authors.forename: Julia
authors.initials: J
authors.lastname: Arfi-Rouche
authors.forename: David
authors.initials: D
authors.lastname: Malka
authors.forename: Stéphane
authors.initials: S
authors.lastname: Ederhy
authors.forename: Hassan
authors.initials: H
authors.lastname: Izzedine
authors.forename: Sophie
authors.initials: S
authors.lastname: Leboulleux
authors.forename: Cécile N
authors.initials: CN
authors.lastname: Chougnet
authors.forename: Pascal
authors.initials: P
authors.lastname: Burtin
authors.forename: Thierry
authors.initials: T
authors.lastname: De Baere
authors.forename: Agnès
authors.initials: A
authors.lastname: Laplanche
authors.forename: Dominique
authors.initials: D
authors.lastname: Elias
authors.forename: Martin
authors.initials: M
authors.lastname: Schlumberger
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Scoazec
authors.forename: Michel
authors.initials: M
authors.lastname: Ducreux
authors.forename: Eric
authors.initials: E
authors.lastname: Baudin
mesh_terms: D000328:Adult; D000368:Aged; D000969:Antinematodal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000969:Antinematodal Agents; D007155:Immunologic Factors
keywords: Neuroendocrine tumour; Pancreatic tumour; Safety; Therapeutic lines