title: Treatment of metastatic pancreatic neuroendocrine tumors: relevance of ENETS 2016 guidelines.
abstract: The choice of first-line treatment for metastatic pancreatic neuroendocrine tumors (mP-NET) is mainly based on prognostic factors. ENETS-2016 guidelines stratified treatment according to 3 groups: Group 1, patients in whom all lesions could be removed; Group 2, patients with Ki67 <10%, low tumor burden, no symptoms and stable disease, for whom a watch-and-wait strategy or somatostatin analogs are proposed; Group 3, symptomatic patients or with Ki67 >10% or significant tumor burden or progressive disease, for whom a systemic chemotherapy is proposed. This retrospective study aimed to determine patient distribution, characteristics and outcome among these 3 groups. Patients with mP-NET diagnosis from 2004 to 2016 were categorized into the three groups. Prognosis was calculated using the Kaplan-Meier method. All treatments were recorded, and consistency with ENETS guidelines was explored. 104 patients were analyzed: 64% synchronous mP-NET, 80% grade 2 tumors and median overall survival (OS) of 104 (95% CI: 65-143) months. There were 15 patients in ENETS Group 1, 16 in Group 2 and 73 in Group 3. Median OS was not reached in Groups 1 and 2 and was 64 months (35-93) in Group 3. High liver tumor volume, high-grade tumor and progressive disease were associated with worse OS in multivariate analysis. The first-line treatment was in accordance with guidelines in 82%. 77% percent of deceased patients received less than 4 lines of treatment. Most patients are in Group 3 and do not receive all available treatments. Thus, trials are warranted to improve first-line chemotherapy. Alternative treatments may be considered for less aggressive disease.
authors.affiliation: Hospices Civils de LyonHôpital Edouard Herriot, Service de Gastroentérologie et d'Oncologie Médicale, Lyon, France.
authors.forename: Margaux
authors.initials: M
authors.lastname: Foulfoin
authors.affiliation: Hospices Civils de LyonHôpital Edouard Herriot, Service de Gastroentérologie et d'Oncologie Médicale, Lyon, France.|University of LyonUniversité Lyon 1, Lyon, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Graillot
authors.affiliation: University of LyonUniversité Lyon 1, Lyon, France.|Hospices Civils de LyonHôpital Edouard Herriot, Service de chirurgie, Lyon, France.
authors.forename: Mustapha
authors.initials: M
authors.lastname: Adham
authors.affiliation: University of LyonUniversité Lyon 1, Lyon, France.|Hospices Civils de LyonHôpital Edouard Herriot, Service de radiologie, Lyon, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Rousset
authors.affiliation: Hospices Civils de LyonHôpital Edouard Herriot, Service de Gastroentérologie et d'Oncologie Médicale, Lyon, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Forestier
authors.affiliation: University of LyonUniversité Lyon 1, Lyon, France.|Hospices Civils de LyonHôpital Edouard Herriot, Service Central d'Anatomie et Cytologie Pathologiques, Lyon, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Hervieu
authors.affiliation: Hospices Civils de LyonDRCI, Lyon, France.
authors.forename: Philip
authors.initials: P
authors.lastname: Robinson
authors.affiliation: Hospices Civils de LyonHôpital Edouard Herriot, Service Central d'Anatomie et Cytologie Pathologiques, Lyon, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Scoazec
authors.affiliation: Hospices Civils de LyonHôpital Edouard Herriot, Service de Gastroentérologie et d'Oncologie Médicale, Lyon, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Lombard-Bohas
authors.affiliation: Hospices Civils de LyonHôpital Edouard Herriot, Service de Gastroentérologie et d'Oncologie Médicale, Lyon, France thomas.walter@chu-lyon.fr.|University of LyonUniversité Lyon 1, Lyon, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Walter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000188:drug therapy / Q000556:secondary; D000068338:Everolimus / Q000627:therapeutic use; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D011758:Pyrroles / Q000627:therapeutic use; D012189:Retrospective Studies; D012955:Societies, Medical; D000077210:Sunitinib; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D007211:Indoles; D011758:Pyrroles; D000068338:Everolimus; D000077210:Sunitinib
keywords: metastasis; neuroendocrine tumors; pancreas; prognosis; treatment