Treatment Patterns and Clinical Outcomes in Advanced Lung Neuroendocrine Tumors in Real-World Settings: A Multicenter Retrospective Chart Review Study

Abstract

Background Using data from four tertiary referral centers in the U.S., we assessed real‐world treatment patterns and clinical outcomes of patients with advanced lung neuroendocrine tumors (NETs). Subjects, Materials, and Methods We performed a retrospective chart review of adult patients with locally advanced/metastatic (typical/atypical) lung NETs treated between July 2011 and December 2014. Index date was histologically confirmed typical/atypical carcinoid tumor diagnosis date. Data included baseline characteristics, treatment patterns, progression, death, and lung NET‐related health care resource use from index date through last contact/death. Time to treatment discontinuation and first progression, time from first to second progression, and overall survival (OS) were estimated using Kaplan‐Meier analysis. Results We identified 83 patients; 19 (23%) had functional NET. First‐line treatments included somatostatin analogs (SSAs) alone (56%) or in combination with other therapies (6%), cytotoxic chemotherapy (20%), external beam radiation therapy (EBRT) (9%), liver‐directed therapy (LDT) (4%), and everolimus/other (5%). Sixty patients had second‐line therapy including SSA alone (18%) or in combination (40%), cytotoxic chemotherapy (17%), everolimus (12%), LDT (7%), EBRT (3%), and other treatments (3%). Median time (months) to first‐line discontinuation were as follows: SSAs, 43.3; cytotoxic chemotherapy, 3.6. Overall median time (months) to investigator‐assessed progression following treatment initiation was 12.4. Median OS (months) following treatment initiation was 66.4 for all patients and 81.5 for patients receiving SSAs. Conclusion SSAs, alone and in combination, are common treatments for advanced lung NETs. Patients have additional treatment options and relatively long survival compared with patients with other advanced cancers. Treatment pattern assessment following approval of newer treatments is needed. Implications for Practice Somatostatin analogs (SSAs), cytotoxic chemotherapy, EBRT, liver‐directed therapy, and targeted therapies are common treatments for locally advanced/metastatic (typical/atypical) lung neuroendocrine tumors (NETs). SSAs alone or in combination with other treatment modalities were the most common first‐ and second‐line therapy, followed by cytotoxic chemotherapy. Patients continued treatment with SSAs long‐term with median treatment duration of 43 months. Median overall survival was 66 months following initiation of first‐line therapy for all patients. Treatment pattern assessment beyond the time period of this study is needed given recent U.S. Food and Drug Administration approvals for additional treatments for lung NETs that will likely be incorporated in the treatment landscape.

Molecular Pathology of Well-Differentiated Pulmonary and Thymic Neuroendocrine Tumors: What Do Pathologists Need to Know?

“…In these patients, first-line treatment includes somatostatin analogs alone or in combination with other therapies, or cytotoxic chemotherapy. These same treatments are also the most adopted as second-line therapy, together with mTOR inhibitors and other regimens in a wide range of schemes and sequences that are heterogeneous even within single institutions [ 96 ]. Molecular predictive biomarkers in the clinical setting are mostly missing.…”

Outcome of Patients With Metastatic Lung Neuroendocrine Tumors Submitted to First Line Monotherapy With Somatostatin Analogs

“…The SPINET trial (NCT02683941), a placebo-controlled randomised phase III study, which was designed to evaluate lanreotide 120 mg in advanced lung carcinoids, was early stopped for insufficient enrolment (20). Most of the published retrospective studies are heterogeneous and included patients with NET of different primaries (21)(22)(23)(24)(25)(26)(27)(28). Only 2 studies evaluated patients with lung carcinoids only.…”

The Role of Conventionally Fractionated Radiotherapy and Stereotactic Radiotherapy in the Treatment of Carcinoid Tumors and Large-Cell Neuroendocrine Cancer of the Lung

“…A patient who did not receive treatment after the first progression was also described. The time to the second progression was 8.5 months, and EBRT was used in the third line [ 65 ]. Unfortunately, the authors of the article did not provide more information on radiotherapy, including the fractionation scheme.…”