Therapeutic strategies for gastroenteropancreatic neuroendocrine neoplasms: State-of-the-art and future perspectives

Predictive factors for efficacy of oxaliplatin-based chemotherapy in advanced well-differentiated neuroendocrine tumors: an observational cohort study and meta-analysis

Background

Oxaliplatin-based chemotherapy (OX-CT) has shown promising antitumor activity in advanced well-differentiated neuroendocrine tumors (WD-NETs). However, no meta-analysis has been conducted to explore the factors associated with ORR and PFS of OX-CT, and data are still limited in Chinese cohort.

Methods

We performed a retrospective cohort study with advanced WD-NETs who received OX-CT. We also conducted a systematic review and performed a meta-analysis to explore factors associated with ORR and PFS.

Results

A total of 27 patients were included, with 21 receiving OX-CT as first line. Furthermore, 18 were of pancreas origin, and the median Ki-67 was 30%. The ORR and DCR were 29.6% and 81.5%, respectively. The median PFS was 9.3 months (95%CI: 4.6-14.0), and OS was not reached. A Ki-67 value >10% predicted higher ORR (36.4% vs. 0.0%, p = 0.28) and better PFS (10.0 vs. 2.1 months, p = 0.06). Patients with hepatic tumor burden ≤25% had a similar ORR (33.3% vs. 22.2%, p = 0.68), but with a trend of longer PFS (10.2 vs. 4.7 months, p = 0.21) than those >25%. Both ORR and PFS were independent of MGMT status. A total of 962 patients were included in the systemic review. The pooled ORR (28.2%, p = 0.84) and DCR (82.9%, p = 0.85) were comparable with this cohort. No difference was observed between GEMOX and FOLFOX/CAPOX in both ORR (23.9% vs. 29.6%, p = 0.19) and PFS (10.5 vs. 11.8 months, p = 0.69). Enhanced ORR was seen in pNETs than epNETs (36.8% vs. 16.7%, p < 0.001) and also in G3 NETs than G1-2 NETs (45.5% vs. 24.7%, p < 0.001). The pooled median PFS and OS were 10.8 months (95%CI: 8.8-12.8) and 30.4 months (95%CI: 24.8-35.9).

Conclusions

Oxaliplatin-based chemotherapy could be a good option for advanced WD-NETs with high Ki-67 index and pancreatic origin.

Liver-Directed Locoregional Therapies for Neuroendocrine Liver Metastases: Recent Advances and Management

Neuroendocrine tumors (NETs) are a heterogeneous class of cancers, predominately occurring in the gastroenteropancreatic system, which pose a growing health concern with a significant rise in incidence over the past four decades. Emerging from neuroendocrine cells, these tumors often elicit paraneoplastic syndromes such as carcinoid syndrome, which can manifest as a constellation of symptoms significantly impacting patients' quality of life. The prognosis of NETs is influenced by their tendency for metastasis, especially in cases involving the liver, where the estimated 5-year survival is between 20 and 40%. Although surgical resection remains the preferred curative option, challenges emerge in cases of neuroendocrine tumors with liver metastasis (NELM) with multifocal lobar involvement, and many patients may not meet the criteria for surgery. Thus, minimally invasive and non-surgical treatments, such as locoregional therapies, have surfaced. Overall, these approaches aim to prioritize symptom relief and aid in overall tumor control. This review examines locoregional therapies, encompassing catheter-driven procedures, ablative techniques, and radioembolization therapies. These interventions play a pivotal role in enhancing progression-free survival and managing hormonal symptoms, contributing to the dynamic landscape of evolving NELM treatment. This review meticulously explores each modality, presenting the current state of the literature on their utilization and efficacy in addressing NELM.