Abstract
OBJECTIVES: This study aimed to develop expert consensus for the use of systemic treatments for unresectable metastatic well-differentiated (grade 1-2) carcinoid tumors using the RAND/UCLA modified Delphi process. METHODS: After a comprehensive literature review, 404 patient scenarios addressing the use of systemic treatments for carcinoid tumors were constructed. A multidisciplinary panel of 10 physicians assessed the scenarios as appropriate, inappropriate, or uncertain (on a 1-9 scale) or as an area of disagreement before and after an extended discussion of the evidence. RESULTS: Experts were medical and surgical oncologists, interventional radiologists, and gastroenterologists. Among rated scenarios, disagreement decreased from 14% before the meeting to 4% after. Consensus statements about midgut carcinoids included the following: (1) Somatostatin analogs are appropriate as first-line therapy for all patients; (2) In patients with uncontrolled secretory symptoms, it is appropriate to increase the dose/frequency of octreotide long-acting repeatable up to 60 mg every 4 weeks or up to 40 mg every 3 weeks as second-line therapy for refractory carcinoid syndrome. Other options may also be appropriate. Consensus was similar for non-midgut carcinoids. CONCLUSIONS: The Delphi process provided a structured methodological approach to assist clinician experts in reaching consensus on the appropriateness of specific medical therapies for the treatment of advanced carcinoid tumors.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 397-404 |
| Number of pages | 8 |
| Journal | Pancreas |
| Volume | 42 |
| Issue number | 3 |
| DOIs | |
| State | Published - Apr 1 2013 |
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Keywords
- Carcinoid tumors
- Intermediate-grade tumors
- Low-grade tumors
- Neuroendocrine carcinomas
- Neuroendocrine tumors
- Well differentiated
ASJC Scopus subject areas
- Internal Medicine
- Endocrinology, Diabetes and Metabolism
- Hepatology
- Endocrinology
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Systemic treatment in unresectable metastatic well-differentiated carcinoid tumors : Consensus results from a modified Delphi process. / Strosberg, Jonathan R.; Fisher, George A.; Benson, Al B.; Malin, Jennifer L.; Cherepanov, Dasha; Broder, Michael S.
In: Pancreas, Vol. 42, No. 3, 01.04.2013, p. 397-404.Research output: Contribution to journal › Article
TY - JOUR
T1 - Systemic treatment in unresectable metastatic well-differentiated carcinoid tumors
T2 - Consensus results from a modified Delphi process
AU - Strosberg, Jonathan R.
AU - Fisher, George A.
AU - Benson, Al B.
AU - Malin, Jennifer L.
AU - Cherepanov, Dasha
AU - Broder, Michael S.
PY - 2013/4/1
Y1 - 2013/4/1
N2 - OBJECTIVES: This study aimed to develop expert consensus for the use of systemic treatments for unresectable metastatic well-differentiated (grade 1-2) carcinoid tumors using the RAND/UCLA modified Delphi process. METHODS: After a comprehensive literature review, 404 patient scenarios addressing the use of systemic treatments for carcinoid tumors were constructed. A multidisciplinary panel of 10 physicians assessed the scenarios as appropriate, inappropriate, or uncertain (on a 1-9 scale) or as an area of disagreement before and after an extended discussion of the evidence. RESULTS: Experts were medical and surgical oncologists, interventional radiologists, and gastroenterologists. Among rated scenarios, disagreement decreased from 14% before the meeting to 4% after. Consensus statements about midgut carcinoids included the following: (1) Somatostatin analogs are appropriate as first-line therapy for all patients; (2) In patients with uncontrolled secretory symptoms, it is appropriate to increase the dose/frequency of octreotide long-acting repeatable up to 60 mg every 4 weeks or up to 40 mg every 3 weeks as second-line therapy for refractory carcinoid syndrome. Other options may also be appropriate. Consensus was similar for non-midgut carcinoids. CONCLUSIONS: The Delphi process provided a structured methodological approach to assist clinician experts in reaching consensus on the appropriateness of specific medical therapies for the treatment of advanced carcinoid tumors.
AB - OBJECTIVES: This study aimed to develop expert consensus for the use of systemic treatments for unresectable metastatic well-differentiated (grade 1-2) carcinoid tumors using the RAND/UCLA modified Delphi process. METHODS: After a comprehensive literature review, 404 patient scenarios addressing the use of systemic treatments for carcinoid tumors were constructed. A multidisciplinary panel of 10 physicians assessed the scenarios as appropriate, inappropriate, or uncertain (on a 1-9 scale) or as an area of disagreement before and after an extended discussion of the evidence. RESULTS: Experts were medical and surgical oncologists, interventional radiologists, and gastroenterologists. Among rated scenarios, disagreement decreased from 14% before the meeting to 4% after. Consensus statements about midgut carcinoids included the following: (1) Somatostatin analogs are appropriate as first-line therapy for all patients; (2) In patients with uncontrolled secretory symptoms, it is appropriate to increase the dose/frequency of octreotide long-acting repeatable up to 60 mg every 4 weeks or up to 40 mg every 3 weeks as second-line therapy for refractory carcinoid syndrome. Other options may also be appropriate. Consensus was similar for non-midgut carcinoids. CONCLUSIONS: The Delphi process provided a structured methodological approach to assist clinician experts in reaching consensus on the appropriateness of specific medical therapies for the treatment of advanced carcinoid tumors.
KW - Carcinoid tumors
KW - Intermediate-grade tumors
KW - Low-grade tumors
KW - Neuroendocrine carcinomas
KW - Neuroendocrine tumors
KW - Well differentiated
UR - http://www.scopus.com/inward/record.url?scp=84884211704&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84884211704&partnerID=8YFLogxK
U2 - 10.1097/MPA.0b013e31826d3a17
DO - 10.1097/MPA.0b013e31826d3a17
M3 - Article
C2 - 23211372
AN - SCOPUS:84884211704
VL - 42
SP - 397
EP - 404
JO - Pancreas
JF - Pancreas
SN - 0885-3177
IS - 3
ER -