J Cancer 2019; 10(27):6876-6887. doi:10.7150/jca.32381

Research Paper

Treatment Patterns and Survival among Patients with Metastatic Gastroenteropancreatic Neuroendocrine Tumours in Sweden - a Population-based Register-linkage and Medical Chart Review Study

Eva Lesén1, Daniel Granfeldt2, Anthony Berthon3, Jérôme Dinet3, Aude Houchard4, Peter Myrenfors5, Åse Björstad2✉, Ingela Björholt1, Anna-Karin Elf6, Viktor Johanson7

1. Former employee of PharmaLex, Gothenburg, Sweden.
2. PharmaLex, Gothenburg, Sweden.
3. Former employee of Ipsen, Boulogne-Billancourt, France.
4. Ipsen, Boulogne-Billancourt, France.
5. Former employee of Ipsen Nordic, Stockholm, Sweden.
6. Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
7. Former employee at Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.

This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions.
Citation:
Lesén E, Granfeldt D, Berthon A, Dinet J, Houchard A, Myrenfors P, Björstad Å, Björholt I, Elf AK, Johanson V. Treatment Patterns and Survival among Patients with Metastatic Gastroenteropancreatic Neuroendocrine Tumours in Sweden - a Population-based Register-linkage and Medical Chart Review Study. J Cancer 2019; 10(27):6876-6887. doi:10.7150/jca.32381. Available from http://www.jcancer.org/v10p6876.htm

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Abstract

Background: Gastroenteropancreatic neuroendocrine tumours (GEP-NETs) are neoplasms derived from the endocrine system in the gastrointestinal tract and pancreas. Treatment options include surgery; pharmacological treatments like somatostatin analogues (SSA), interferon alpha, molecular targeted therapy and chemotherapy; and peptide receptor radionuclide therapy.

The objective of this study was to describe treatment patterns and survival among patients with metastatic GEP-NET grade 1 or 2 in Sweden.

Methods: Data was obtained via linkage of nationwide registers. Patients diagnosed with metastatic GEP-NET grade 1 or 2 in Sweden between 2005 and 2013 were included (n=811; National population). In addition, medical chart review was performed for the subpopulation diagnosed at Sahlgrenska University Hospital, Gothenburg (n=127; Regional population). Treatment patterns, including treatment sequences, and overall survival were assessed.

Results: Most patients had small intestinal NET (76%). In the regional population, 72% had grade 1 tumours; 50% had functioning tumours. The two most common first-line treatments were surgery (57%) and SSA (25%). After first-line surgery, 46% received SSA, while 40% had no further treatment. After first-line SSA, 52% received surgery, while 27% had no further treatment. Overall median survival time from date of diagnosis was 7.0 years (95% CI 6.2-not reached). Among patients with distant metastases, pancreatic NET (vs. small intestinal NET) was associated with poorer survival (HR 1.9; 95% CI 1.1-3.3), as were liver metastases (HR 3.2; 95% CI 1.5-7.0).

Conclusions: First-line surgery was typically followed by SSA or no further treatment. Among patients with distant metastases, pancreatic NET or liver metastases were associated with a poorer survival.

Keywords: GEP-NET, metastatic, SSA, surgery, treatment patterns, survival.