Treatment Patterns and Health Resource Use Among Patients with Metastatic Gastroenteropancreatic Neuroendocrine Tumors Treated at a Tertiary Referral Center

Abstract

Background. Although an increasing number of treatments have become available for patients with advanced gastroenteropancreatic neuroendocrine tumors (GEP-NETs), there remains little consensus on treatment sequence and its impact on health care resource use (HRU). We sought to describe treatment patterns and HRU, in a cohort of patients with metastatic GEP-NETs treated at a tertiary referral center in the U.S. Materials and Methods. We identified patients with a welldifferentiated, metastatic GEP-NET evaluated at Dana-Farber Cancer Institute between July 2003 and May 2015. For these patients, we describe the sequence of treatment regimens received for their disease, together with associated HRU. Results. We identified 682 patients with advanced GEP-NETs. Of these patients, 597 (87.0%) initiated ≥1 treatment over the follow-up period. The mean age at diagnosis was 58.5 years, 50.2% were men, and 94.0% were white. A total of 83.1% initiated a somatostatin analog (SSA) as their firstline treatment, with 55% and 31% of patients continuing with second-and third-line therapies. A total of 31.2% of patients with SSAs underwent dose escalation to above standard dose. In this setting, patients with pancreatic neuroendocrine tumors were more commonly treated with cytotoxic regimens than other NET tumor types and also had higher HRU. Conclusion. Our study suggests that, at a tertiary referral center, patients with advanced NETs commonly received multiple courses of treatments. Our data suggest a clear preference for use of SSAs as a first-line treatment for patients with advanced NETs, with SSAs commonly escalated and continued throughout the course of treatment in combination with other regimens. The Oncologist 2020;25:e644-e650 Implications for Practice: The current study demonstrates the common use of somatostatin analog as a first-line therapy for patients with advanced gastroenteropancreatic neuroendocrine tumors as well as the incorporation of multiple different treatment regimens in the treatment course of patients with this disease. Jalbert, Casciano, Meng et al. e645 3. Rinke A, Muller HH, Schade-Brittinger C et al. Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors:

Advances in the treatment of gastroenteropancreatic neuroendocrine neoplasms with somatostatin analogs

“…In 2020, a real-world study conducted at the Dana-Farber Cancer Institute, included 682 patients with well-differentiated metastatic GEP-NETs. [14,18] It was found that the SSA monotherapy was the most commonly chosen first-line regimen in metastatic GEP-NETs (69.7%). Besides, under the first-line setting, in 13.4% of the patients, SSAs were combined with other treatments.…”

“…A real-world study showed that SSA-based combination therapy was the most common second-line option for GEP-NETs. [14,17] As for the second-line therapies used in this study, 77.9% of the pNETs patients, 96.6% of the midgut NETs patients, and 78.7% of the patients with other primary locations were given SSA-based combination therapy. In these treatments, the drugs used concomitantly with SSAs included cytotoxic agents, everolimus, interferon, and investigational drugs.…”

Characteristics and treatment results of patients with gastroenteropancreatic neuroendocrine tumors in a tertiary care centre

“…Of 26 patients in our study undergoing primary medical therapy, 12 received second-line systemic therapy, while 5 underwent salvage therapy. Others have reported 55% second-line therapy and 31% third-line therapy in patients with metastatic GEP-NET [20].…”

Opportunities to Improve Symptom Control with Somatostatin Congeners in GEP-NETs: A Review of Key Issues

“…In pre-pandemic studies, patients with NETs averaged 25.7 outpatient visits and 5.6 inpatient visits annually, with the most common being visits to oncologist offices. 18,53 In response to governmental regulations and individual health concerns, oncology patient visits dropped dramatically in 2020 and, despite the lifting of stay-at-home orders, oncology service utilization continues to lag behind 2019 levels. 54 In an observational multi-center study, up to 40% of patients interrupted their therapy over the past year, due in part to the pandemic's impact on in-office visits.…”

“…Treatment of NETs is a health resource‐heavy process. In prepandemic studies, patients with NETs averaged 25.7 outpatient visits and 5.6 inpatient visits annually, with the most common being visits to oncologist offices [ 18 , 53 ].…”