Comparison of Chemotherapeutic Treatment Outcomes of Advanced Extrapulmonary Neuroendocrine Carcinomas and Advanced Small-Cell Lung Carcinoma

Abstract

Background: The chemotherapy for small-cell lung carcinoma (SCLC) has been adopted for advanced extrapulmonary neuroendocrine carcinomas (EP-NECs). The aim of this study was to clarify the efficacy of standard SCLC regimens when used to treat EP-NECs and to compare the outcome with that for SCLC. Methods: We reviewed the medical records of 136 patients (41 with EP-NEC and 95 with SCLC) who were treated using a platinum-containing regimen for advanced disease between January 2000 and October 2008 at our hospital. Results: The primary site of the EP-NEC was the gastrointestinal tract in 18 patients (GI tract group); the liver, biliary tract or pancreas in 16 patients (HBP group), and other sites in 7 patients (‘others’ group). The response rate in the SCLC patients was 77.8%, and the response rate in the EP-NEC patients was 30.8% (37.5% in the GI tract group, 12.5% in the HBP group, and 57.1% in the ‘others’ group). The median survival time for the SCLC patients was 13.6 months, while that for the EP-NEC patients was 9.2 months (14.9 months in the GI tract group, 7.8 months in the HBP group, and 8.9 months in the ‘others’ group). A multivariate analysis demonstrated that a poor performance status, liver involvement, and the treatment regimen were independent unfavorable prognostic factors. Conclusion: The response rate and prognosis of the patients with advanced EP-NECs were worse than those of the patients with SCLC in this study. The Eastern Cooperative Oncology Group performance status, liver involvement, and treatment regimen had a larger impact on the prognosis than the primary tumor site, as demonstrated by multivariate analysis.

Pancreatic Neuroendocrine Neoplasms: Basic Biology, Current Treatment Strategies and Prospects for the Future

“…Based on meta-analysis and a phase III trial for SCLC, CBDCA and CPT-11 are practically recognized as equally effective compared to CDDP and ETP, respectively [77,78]. However, retrospective studies indicated that response to platinum regimens and survival are different between SCLC and extrapulmonary NEC, which suggests that extrapolation from SCLC data is not necessarily reliable [79][80][81]. The first randomized phase III trial between EP and IP regimens in GEP-NEC patients (JCOG 1213 trial) is currently being conducted by the Japan Clinical Oncology Group [82].…”

Extrapulmonary small cell carcinoma of lymph node: Pooled analysis of all reported cases

“…Eight studies (n = 14) were included in the current analysis ( Figure 6) [16][17][18][19][20][21][22][23] . Studies that did not provide separate information for patients with LNEPSCC [29][30][31][32][33][34][35][36][37][38][39][40][41] , and the treatment given or follow up were not included in the current review [42][43][44][45][46][47][48][49][50] . A total of 17 patients including the three index cases (mean ± SD, 59.5 ± 10.8 years; 81.8% males) with LNEPSCC were included in the current analysis (Table 1).…”

Extrapulmonary neuroendocrine small and large cell carcinomas: a review of controversial diagnostic and therapeutic issues

“…The reason for this question relies on the comparable overall survival for surgically resected pulmonary SCC and LCNEC, with figures of approximately 35% and 40%, respectively [60]. In this scenario, however, relatively recent reports seem to indicate a unique response rate of EPNEC to chemotherapy protocols conventionally used for pulmonary SCC [61].…”

“…Since LCNECs of the lung, at least in their advanced stage, are also treated similarly to SCC [66], the whole spectrum of EPNEC generally undergoes the same chemotherapy approach. Indeed, some reports indicate that despite that the chemotherapy protocols are quite similar, response to therapy is different and the stability of disease after completion of chemotherapy may follow a different course [61,63,67].…”

“…In 21 unresectable or recurrent hepatobiliary and pancreatic EPNECs, combination chemotherapy with cisplatin and etoposide provided a 14% response rate and a median overall survival of 5.8 months [71]. Comparing the efficacy of a platinum-containing regimen in 41 advanced EPNECs with that of SCC of the lung, the response rates were much worse in the former (31% versus 78%) [61]. This remarkable discrepancy might be due to the different nature of the 2 tumors (classical pulmonary SCCs are highly chemosensitive undifferentiated neoplasm, while EPNEC include more heterogeneous cancer subtypes), or to the anatomical location of the tumors, as partially confirmed by the worse response of hepatobiliary and pancreatic NECs (12% versus 57% for the other locations).…”