Introduction Recent classification of neuroendocrine neoplasms has defined well‐differentiated high‐grade neuroendocrine tumors (NET G3) as a distinct entity from poorly differentiated neuroendocrine carcinoma. The optimal treatment for NET G3 has not been well‐described. This study aimed to evaluate metastatic NET G3 response to different treatment regimens. Materials and Methods This was a retrospective study of patients with NET G3 within the Mayo Clinic database. Patients’ demographics along with treatment characteristics, responses, and survival were assessed. Primary endpoints were progression‐free survival (PFS) and overall survival. Secondary endpoints were objective response rate (ORR) and disease control rate (DCR). Results Treatment data was available in 30 patients with median age of 59.5 years at diagnosis. The primary tumor was mostly pancreatic (73.3%). Ki‐67 index was ≥55% in 26.7% of cases. Treatments included capecitabine + temozolomide (CAPTEM) (n = 20), lutetium 177 DOTATATE (PRRT; n = 10), Platinum‐etoposide (EP; n = 8), FOLFOX (n = 7), and everolimus (n = 2). CAPTEM exhibited ORR 35%, DCR 65%, and median PFS 9.4 months (95% confidence interval, 2.96–16.07). Both EP and FOLFOX showed similar radiographic response rates with ORR 25.0% and 28.6%; however, median PFS durations were quite distinct at 2.94 and 13.04 months, respectively. PRRT had ORR of 20%, DCR of 70%, and median PFS of 9.13 months. Conclusion Among patients with NET G3, CAPTEM was the most commonly used treatment with clinically meaningful efficacy and disease control. FOLFOX or PRRT are other potentially active treatment options. EP has some activity in NET G3, but responses appear to be short‐lived. Prospective studies evaluating different treatments effects in patients with NET G3 are needed to determine an optimal treatment strategy. Implications for Practice High‐grade well‐differentiated neuroendocrine tumors (NET G3) are considered a different entity from low‐grade NET and neuroendocrine carcinoma in terms of prognosis and management. The oral combination of capecitabine and temozolomide is considered a good option in the management of metastatic NET G3 and may be preferred. FOLFOX is another systemic option with reasonable efficacy. Similar to other well‐differentiated neuroendocrine tumors, peptide receptor radionuclide therapy seems to have some efficacy in these tumors.
Summary Background A student‐run free clinic (SRFC) is a health care delivery system in which undergraduate medical students assume the responsibility of an outpatient health clinic. This provides a unique opportunity for early exposure to patients in a student's pre‐clinical years. Methods Pre‐ and post‐experience electronic surveys were sent out to first‐year medical students who were required to complete a minimum of three sessions as a volunteer at one of two SRFCs in the metro Detroit area. The Fisher's exact test was used to assess for a significant change after clinic experience with p < 0.05. Results Thirty‐one students completed the pre‐experience survey. Twenty‐five students completed the post‐experience survey. The Fisher's exact test demonstrated a significant increase in the proportion of positive answers for questions concerning comfort with taking a medical history (p = 0.002) and comfort with using an electronic medical record (EMR) (p = 0.048). There was no significant difference in comfort working as part of a team (p = 0.581), discussing a patient with a physician (p = 0.602) or interacting with different socio‐economic backgrounds (p = 0.720). Conclusion SRFCs provide a beneficial opportunity for early patient and clinical exposure for pre‐clinical medical students, including practice using an EMR, which is an essential tool in our electronic era. More research, however, is needed to determine the most effective way to teach skillful EMR use.
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