Tumori neuroendocrini a basso grado di malignità. Trattamento con octreotide LAR. Studio di Fase II

Nel maggio 2000 é stato avviato uno studio sui tumori neuroendocrini a basso grado di malignità.

Lo studio (Protocollo 19/00) aveva l’obiettivo di valutare se la nuova classificazione anatomo-patologica dei tumori neuroendocrini potesse fornire un adeguato supporto per la scelta del trattamento medico.

Sono stati arruolati 31 pazienti.

Lo studio ha dimostrato che la classificazione dei tumori neuroendocrini forniva informazioni utili per la selezione dei pazienti candidabili al trattamento ormonale, anche se una quota di pazienti dimostrava caratteristiche cliniche non allineabili con la diagnosi istologica.

Centri partecipanti :                     Istituto Nazionale Tumori, MILANO

Ospedale S. Vincenzo, TAORMINA

Università degli Studi, CHIETI

Riferimento Bibliografico:

  • Is the new WHO classification of neuroendocrine tumours useful for selecting an appropriate treatment?
    (E. Bajetta, L. Catena, G. Procopio, E. Bichisao, L. Ferrari, S. Della Torre, S. De Dosso, S. Iacobelli, R. Buzzoni, L. Mariani, J. Rosai).
    Ann Oncol. 2005 Aug;16(8):1374-80. Epub 2005 Jun 6.
    AbstractBACKGROUND:
    Neuroendocrine tumours (NETs) are a rare and heterogeneous group of neoplasms. The most recent WHO classification provides clinical tools and indications to make the diagnosis and to suggest the correct treatment in different subgroups of patients. The aim of this trial was to apply the new classification criteria in clinical practice and, accordingly, to choose the most appropriate treatment.PATIENTS AND METHODS:
    Thirty-one evaluable patients, not previously treated, classified as advanced well differentiated NETs according to the new classification, were given long-acting release octreotide 30 mg every 28 days until evidence of disease progression. The treatment activity was evaluated according to objective, biochemical and symptomatic responses. Safety and tolerability were also assessed.

    RESULTS:
    Two partial objective tumour responses were obtained (6%), stabilization occurred in 16 patients (52%) and 95% of patients had a disease stabilisation lasting > or =6 months. However, eight patients showed rapid disease progression within 6 months of therapy and six patients after 6 months. Biochemical responses, evaluated by changes in serum chromogranine A levels were reported in 20/24 patients (83%). Symptomatic responses were observed in 6/14 patients (43%): a complete syndrome remission in one patient, partial syndrome remission in five patients, no change in four patients and progressive disease in four patients. The median overall survival was not reached, and the median time to disease progression was 18 months (range 1-49 months). The treatment was well tolerated, no severe adverse events were observed and no patient withdrew from the study because of adverse events.

    CONCLUSIONS:
    The WHO classification enables identification of low-grade NET patients who may be suitable for hormonal treatment. Octreotide LAR was seen to be effective in controlling the disease and was well tolerated. However, eight patients failed to respond to the treatment, despite histological evidence of a well differentiated tumour according to the new classification. This suggests that further histological examination should be carried out, especially in patients with visceral metastases and a short disease-free interval.

    PMID: 15939719   [PubMed – indexed for MEDLINE]

    Download articolo: Ann Oncol. 2005