Autopsy and Case Reports
https://app.periodikos.com.br/journal/autopsy/article/doi/10.4322/acr.2018.005
Autopsy and Case Reports
Article / Clinical Case Report

Huge recurrent gastric neuroendocrine tumor: a second-line chemotherapeutic dilemma

Maria João Marques Ribeiro; Teresa Alonso; Pablo Gajate; Javier Molina; Arantzazu Barquin; Cristian Perna; Enrique Grande

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Abstract

Chemotherapy is considered “state of the art” for the treatment of poorly differentiated neuroendocrine neoplasms. Unfortunately, there is no standard effective post-first-line treatment for relapsing high-grade gastroenteropancreatic neuroendocrine neoplasms. We report the case of a patient with a gastric neuroendocrine carcinoma stage IV, with massive gastrointestinal bleeding at diagnosis. After the first line of platin-based chemotherapy a major tumoral response was documented, but the patient relapsed after 4 months. A second line of chemotherapy treatment was given, with the FOLFOX regimen, and the patient has been free of progression for almost 2 years. There is no second-line standard treatment accepted for this type of carcinoma, but 5-fluorouracil combined with oxaliplatin showed interesting antitumor activity.

Keywords

Carcinoma, Neuroendocrine, Stomach Neoplasms, Neoplasm Metastases, Medical Oncology

References

Yao JC, Hassan M, Phan A, et al. One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol. 2008;26(18):3063-72. [PMID:18565894] [https://doi.org/10.1200/JCO.2007.15.4377].

Öberg K, Knigge U, Kwekkeboom D, Perren A. Neuroendocrine gastro-entero-pancreatic tumors: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012;23(Suppl 7):vii124-30. [PMID:22997445]

Frilling A, Modlin IM, Kidd M, et al. Recommendations for management of patients with neuroendocrine liver metastases. Lancet Oncol. 2014;15(1):e8-21. [PMID:24384494] [https://doi.org/10.1016/S1470-2045(13)70362-0].

Delle Fave G, O′'Toole D, Sundin A, et al. ENETS Consensus Conference participants: ENETS consensus guidelines update for gastroduodenal neuroendocrine neoplasms. Neuroendocrinology. 2016;103(2):119-24. [PMID:26784901] [https://doi.org/10.1159/000443168].

Rindi G, Arnold R, Bosman FT, et al. Nomenclature and classification of neuroendocrine neoplasms of the digestive system. In: Bosman FT, Carneiro F, Hruban RH, et al., editors. WHO classification of tumors of the digestive system. Lyon: IARC; 2010. p. 13-145.

Pape UF, Jann H, Muller-Nordhorn J, et al. Prognostic relevance of a novel TNM classification system for upper gastroenteropancreatic neuroendocrine tumors. Cancer. 2008;113(2):256-65. [PMID:18506737] [https://doi.org/10.1002/cncr.23549].

Rockall AG, Reznek RH. Imaging of neuroendocrine tumours (CT/MR/US). Best Pract Res Clin Endocrinol Metab. 2007;21(1):43-68. [PMID:17382265] [https://doi.org/10.1016/j.beem.2007.01.003].

Bongiovanni A, Riva N, Ricci M, et al. First-line chemotherapy in patients with metastatic gastroenteropancreatic neuroendocrine carcinoma. Onco Targets Ther. 2015;8:3613-9. [PMID:26664145] [https://doi.org/10.2147/OTT.S91971].

Kim HK, Ha SY, Lee J, et al. The impact of pathologic differentiation (well/poorly) and the degree of Ki-67 index in patients with metastatic WHO grade 3 GEP-NECs. Oncotarget. 2017;8(43):73974-80. [PMID:29088761]

Sorbye H, Welin S, Langer SW, et al. Predictive and prognostic factors for treatment and survival in 305 patients with advanced gastrointestinal neuroendocrine carcinoma (WHO grade 3): the NORDIC NEC study. Ann Oncol. 2013;24(1):152-60. [PMID:22967994] [https://doi.org/10.1093/annonc/mds276].

Mitry E, Baudin E, Ducreux M, et al. Treatment of poorly differentiated neuroendocrine tumours with etoposide and cisplatin. Br J Cancer. 1999;81(8):1351-5. [PMID:10604732] [https://doi.org/10.1038/sj.bjc.6690325].

Fazio N, Milione M. Heterogeneity of grade 3 gastroenteropancreatic neuroendocrine carcinomas: new insights and treatment implications. Cancer Treat Rev. 2016;50:61-7. [PMID:27636009] [https://doi.org/10.1016/j.ctrv.2016.08.006].

Hentic O, Hammel P, Couvelard A, et al. FOLFIRI regimen: an effective second-line chemotherapy after failure of etoposide-platinum combination in patients with neuroendocrine carcinomas grade 3. Endocr Relat Cancer. 2012;19(6):751-7. [PMID:22940375] [https://doi.org/10.1530/ERC-12-0002].

Hadoux J, Malka D, Planchard D, et al. Post-first line FOLFOX chemotherapy in Grade 3 neuroendocrine carcinoma. Endocr Relat Cancer. 2015;22(3):289-98. [PMID:25770151] [https://doi.org/10.1530/ERC-15-0075].

Spada F, Antonuzzo L, Marconcini R, et al. Oxaliplatin-based chemotherapy in advanced neuroendocrine tumors: clinical outcomes and preliminary correlation with biological factors. Neuroendocrinology. 2016;103(6):806-14. [PMID:26789262] [https://doi.org/10.1159/000444087].

Welin S, Sorbye H, Sebjornsen S, Knappskog S, Busch C, Oberg K. Clinical effect of temozolomide-based chemotherapy in poorly differentiated endocrine carcinoma after progression on first-line chemotherapy. Cancer. 2011;117(20):4617-22. [PMID:21456005] [https://doi.org/10.1002/cncr.26124].

Sorbye H, Strosberg J, Baudin E, Klimstra DS, Yao JC. Gastroenteropancreatic high-grade neuroendocrine carcinoma. Cancer. 2014;120(18):2814-23. [PMID:24771552] [https://doi.org/10.1002/cncr.28721].


Publication date:
02/16/2018

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