Systemic treatment in unresectable metastatic well-differentiated carcinoid tumors

Consensus results from a modified Delphi process

Jonathan R. Strosberg, George A. Fisher, Al B Benson III, Jennifer L. Malin, Dasha Cherepanov, Michael S. Broder*

*Corresponding author for this work

Research output: Contribution to journalArticle

17 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)397-404
Number of pages8
JournalPancreas
Volume42
Issue number3
DOIs
StatePublished - Apr 1 2013

Fingerprint

Carcinoid Tumor
Therapeutics
Octreotide
Somatostatin
Physicians

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

Cite this

Strosberg, Jonathan R. ; Fisher, George A. ; Benson III, Al B ; Malin, Jennifer L. ; Cherepanov, Dasha ; Broder, Michael S. / Systemic treatment in unresectable metastatic well-differentiated carcinoid tumors : Consensus results from a modified Delphi process. In: Pancreas. 2013 ; Vol. 42, No. 3. pp. 397-404.
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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 III, 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 journalArticle

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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 III, Al B

AU - Malin, Jennifer L.

AU - Cherepanov, Dasha

AU - Broder, Michael S.

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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.

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