![]() ![]() Hence, therapy-related adverse events can occur during the course of the disease and can forbid further therapeutic lines. Since metastatic GEPNET are low-growing neoplasms, characterised by stability followed by progression, multiple lines of treatment have to be adopted to control distant localisations and symptoms. For foregut patients the choices are multiple, starting from molecular targeting therapies (everolimus and Sunitinib (a tyrosine kinase inhibitor)) 11, following with alkylating chemotherapies as Capecitabine and Temozolomide combination 12 to end with PRRT 13, 14, 15, 16, 17, 18. For midgut patients, PRRT and everolimus (an mTOR inhibitor) are the two main choices 9, 10. In case of progressive metastatic spread, a systemic approach is required and must be selected in accordance with the primary tumor localisation. For oligometastatic liver disease, a loco-regional approach can be applied as ablation or trans-arterial chemoembolisation (TACE) or radioembolisation (TARE). The burden of disease, the location of primary tumor and metastasis as well as the tumor biology are the main aspects to consider in the treatment choice. In case of progression, even after SSA dosage increase, local or systemic approaches have to be considered. At the present, Somatostatin Analogues (SSA) represents the first treatment in the management of unresectable disease, reducing both hormone production and tumor growth. In case of liver metastasis, only 5–15% of patients are eligible for liver metastasIs resection 7, 8. Surgery of primary tumor represents the only curative treatment, with a 5-year survival rate between 60–80%. Ki-67 20% and/or mitotic index > 20 HPF as G3.Īlthough GEPNET are considered low-growing tumors, up to 90% of patients have lymph node metastasis and in 45–70% of cases liver metastasis are present at the time of diagnosis 6, 7. According to WHO 2019 classification 5, the GEPNETs are classified into three groups, on the basis of the proliferation index (Ki-67) and the number of mitotic figures per 2 mm 2. The incidence in Europe appears to be lower and ranges between 1.33 and 2.33/100,000 per year, although the data are retrospective and heterogeneous 2, 3, 4. ![]() The Surveillance, Epidemiology End Results (SEER) database has estimated an incidence of 3.56/100,000 per year in the USA. Gastroenteropancreatic Neuroendocrine Tumors (GEPNET) constitutes a subgroup of NETs which are diagnosed as low-grade lesions in the majority of cases. Neuroendocrine tumors (NETs) are a heterogeneous group of well differentiated neoplasms, considered rare malignancies, even if the incidence has increased more than 6 times in the last decades 1. The application of FLIC model can be useful to improve GEPNET decision-making, allowing clinicians to identify the better therapeutic sequence to avoid PRRT-related adverse events, on the basis of patient characteristics and previous treatment lines. The model performance, expressed by AUC, was > 65% for anaemia, creatinine and eGFR. Line of PRRT administration, age, gender and ECOG-PS were the main predictors of haematological, liver and renal CTCAE. All the patients showed at least one G1–G2, meanwhile G3–G5 were rare events. They were treated with PRRT as third or further lines in 34.3% of cases. Sixty-seven patients (31 males, 36 females, mean age 63) treated with PRRT were considered and followed up for 30 weeks from the beginning of the therapy. A subsampling approach was implemented to assess variable selection stability and model performance. A FLIC model with backward selection was used to detect the most relevant predictors. Patients were grouped according with ECOG-PS, number of metastatic sites, previous treatment lines and therapies received before PRRT. Haematological, liver and renal toxicities were collected and graded according to CTCAE v5. Metastatic GEPNETs patients treated in our centre with PRRT (177Lu-Oxodotreotide) from 2019 to 2020 were considered. To develop predictive models of side effect occurrence in GEPNET treated with PRRT. ![]()
0 Comments
Leave a Reply. |