Treatment Patterns and Clinical Outcomes in Advanced Lung Neuroendocrine Tumors in Real-World Settings: A Multicenter Retrospective Chart Review Study

Arvind Dasari, Emily K. Bergsland, Al B Benson III, Beilei Cai, Lynn Huynh, Todor Totev, Jerome Shea, Mei Sheng Duh, Maureen P. Neary, Cecile G. Dagohoy, Brandon E. Shih, Victoria E. Maurer, Jennifer Chan, Matthew H. Kulke

Research output: Contribution to journalArticle

Abstract

Background: Using data from four tertiary referral centers in the U.S., we assessed real-world treatment patterns and clinical outcomes of patients with advanced lung neuroendocrine tumors (NETs). Subjects, Materials, and Methods: We performed a retrospective chart review of adult patients with locally advanced/metastatic (typical/atypical) lung NETs treated between July 2011 and December 2014. Index date was histologically confirmed typical/atypical carcinoid tumor diagnosis date. Data included baseline characteristics, treatment patterns, progression, death, and lung NET-related health care resource use from index date through last contact/death. Time to treatment discontinuation and first progression, time from first to second progression, and overall survival (OS) were estimated using Kaplan-Meier analysis. Results: We identified 83 patients; 19 (23%) had functional NET. First-line treatments included somatostatin analogs (SSAs) alone (56%) or in combination with other therapies (6%), cytotoxic chemotherapy (20%), external beam radiation therapy (EBRT) (9%), liver-directed therapy (LDT) (4%), and everolimus/other (5%). Sixty patients had second-line therapy including SSA alone (18%) or in combination (40%), cytotoxic chemotherapy (17%), everolimus (12%), LDT (7%), EBRT (3%), and other treatments (3%). Median time (months) to first-line discontinuation were as follows: SSAs, 43.3; cytotoxic chemotherapy, 3.6. Overall median time (months) to investigator-assessed progression following treatment initiation was 12.4. Median OS (months) following treatment initiation was 66.4 for all patients and 81.5 for patients receiving SSAs. Conclusion: SSAs, alone and in combination, are common treatments for advanced lung NETs. Patients have additional treatment options and relatively long survival compared with patients with other advanced cancers. Treatment pattern assessment following approval of newer treatments is needed. Implications for Practice: Somatostatin analogs (SSAs), cytotoxic chemotherapy, EBRT, liver-directed therapy, and targeted therapies are common treatments for locally advanced/metastatic (typical/atypical) lung neuroendocrine tumors (NETs). SSAs alone or in combination with other treatment modalities were the most common first- and second-line therapy, followed by cytotoxic chemotherapy. Patients continued treatment with SSAs long-term with median treatment duration of 43 months. Median overall survival was 66 months following initiation of first-line therapy for all patients. Treatment pattern assessment beyond the time period of this study is needed given recent U.S. Food and Drug Administration approvals for additional treatments for lung NETs that will likely be incorporated in the treatment landscape.

Original languageEnglish (US)
JournalOncologist
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Neuroendocrine Tumors
Lung
Somatostatin
Therapeutics
Drug Therapy
Radiotherapy
Survival
Liver

Keywords

  • Lung neuroendocrine tumor
  • Real-world analysis
  • Somatostatin analogs
  • Treatment patterns

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Dasari, Arvind ; Bergsland, Emily K. ; Benson III, Al B ; Cai, Beilei ; Huynh, Lynn ; Totev, Todor ; Shea, Jerome ; Duh, Mei Sheng ; Neary, Maureen P. ; Dagohoy, Cecile G. ; Shih, Brandon E. ; Maurer, Victoria E. ; Chan, Jennifer ; Kulke, Matthew H. / Treatment Patterns and Clinical Outcomes in Advanced Lung Neuroendocrine Tumors in Real-World Settings : A Multicenter Retrospective Chart Review Study. In: Oncologist. 2019.
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abstract = "Background: Using data from four tertiary referral centers in the U.S., we assessed real-world treatment patterns and clinical outcomes of patients with advanced lung neuroendocrine tumors (NETs). Subjects, Materials, and Methods: We performed a retrospective chart review of adult patients with locally advanced/metastatic (typical/atypical) lung NETs treated between July 2011 and December 2014. Index date was histologically confirmed typical/atypical carcinoid tumor diagnosis date. Data included baseline characteristics, treatment patterns, progression, death, and lung NET-related health care resource use from index date through last contact/death. Time to treatment discontinuation and first progression, time from first to second progression, and overall survival (OS) were estimated using Kaplan-Meier analysis. Results: We identified 83 patients; 19 (23{\%}) had functional NET. First-line treatments included somatostatin analogs (SSAs) alone (56{\%}) or in combination with other therapies (6{\%}), cytotoxic chemotherapy (20{\%}), external beam radiation therapy (EBRT) (9{\%}), liver-directed therapy (LDT) (4{\%}), and everolimus/other (5{\%}). Sixty patients had second-line therapy including SSA alone (18{\%}) or in combination (40{\%}), cytotoxic chemotherapy (17{\%}), everolimus (12{\%}), LDT (7{\%}), EBRT (3{\%}), and other treatments (3{\%}). Median time (months) to first-line discontinuation were as follows: SSAs, 43.3; cytotoxic chemotherapy, 3.6. Overall median time (months) to investigator-assessed progression following treatment initiation was 12.4. Median OS (months) following treatment initiation was 66.4 for all patients and 81.5 for patients receiving SSAs. Conclusion: SSAs, alone and in combination, are common treatments for advanced lung NETs. Patients have additional treatment options and relatively long survival compared with patients with other advanced cancers. Treatment pattern assessment following approval of newer treatments is needed. Implications for Practice: Somatostatin analogs (SSAs), cytotoxic chemotherapy, EBRT, liver-directed therapy, and targeted therapies are common treatments for locally advanced/metastatic (typical/atypical) lung neuroendocrine tumors (NETs). SSAs alone or in combination with other treatment modalities were the most common first- and second-line therapy, followed by cytotoxic chemotherapy. Patients continued treatment with SSAs long-term with median treatment duration of 43 months. Median overall survival was 66 months following initiation of first-line therapy for all patients. Treatment pattern assessment beyond the time period of this study is needed given recent U.S. Food and Drug Administration approvals for additional treatments for lung NETs that will likely be incorporated in the treatment landscape.",
keywords = "Lung neuroendocrine tumor, Real-world analysis, Somatostatin analogs, Treatment patterns",
author = "Arvind Dasari and Bergsland, {Emily K.} and {Benson III}, {Al B} and Beilei Cai and Lynn Huynh and Todor Totev and Jerome Shea and Duh, {Mei Sheng} and Neary, {Maureen P.} and Dagohoy, {Cecile G.} and Shih, {Brandon E.} and Maurer, {Victoria E.} and Jennifer Chan and Kulke, {Matthew H.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1634/theoncologist.2018-0520",
language = "English (US)",
journal = "Oncologist",
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Dasari, A, Bergsland, EK, Benson III, AB, Cai, B, Huynh, L, Totev, T, Shea, J, Duh, MS, Neary, MP, Dagohoy, CG, Shih, BE, Maurer, VE, Chan, J & Kulke, MH 2019, 'Treatment Patterns and Clinical Outcomes in Advanced Lung Neuroendocrine Tumors in Real-World Settings: A Multicenter Retrospective Chart Review Study' Oncologist. https://doi.org/10.1634/theoncologist.2018-0520

Treatment Patterns and Clinical Outcomes in Advanced Lung Neuroendocrine Tumors in Real-World Settings : A Multicenter Retrospective Chart Review Study. / Dasari, Arvind; Bergsland, Emily K.; Benson III, Al B; Cai, Beilei; Huynh, Lynn; Totev, Todor; Shea, Jerome; Duh, Mei Sheng; Neary, Maureen P.; Dagohoy, Cecile G.; Shih, Brandon E.; Maurer, Victoria E.; Chan, Jennifer; Kulke, Matthew H.

In: Oncologist, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Treatment Patterns and Clinical Outcomes in Advanced Lung Neuroendocrine Tumors in Real-World Settings

T2 - A Multicenter Retrospective Chart Review Study

AU - Dasari, Arvind

AU - Bergsland, Emily K.

AU - Benson III, Al B

AU - Cai, Beilei

AU - Huynh, Lynn

AU - Totev, Todor

AU - Shea, Jerome

AU - Duh, Mei Sheng

AU - Neary, Maureen P.

AU - Dagohoy, Cecile G.

AU - Shih, Brandon E.

AU - Maurer, Victoria E.

AU - Chan, Jennifer

AU - Kulke, Matthew H.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Using data from four tertiary referral centers in the U.S., we assessed real-world treatment patterns and clinical outcomes of patients with advanced lung neuroendocrine tumors (NETs). Subjects, Materials, and Methods: We performed a retrospective chart review of adult patients with locally advanced/metastatic (typical/atypical) lung NETs treated between July 2011 and December 2014. Index date was histologically confirmed typical/atypical carcinoid tumor diagnosis date. Data included baseline characteristics, treatment patterns, progression, death, and lung NET-related health care resource use from index date through last contact/death. Time to treatment discontinuation and first progression, time from first to second progression, and overall survival (OS) were estimated using Kaplan-Meier analysis. Results: We identified 83 patients; 19 (23%) had functional NET. First-line treatments included somatostatin analogs (SSAs) alone (56%) or in combination with other therapies (6%), cytotoxic chemotherapy (20%), external beam radiation therapy (EBRT) (9%), liver-directed therapy (LDT) (4%), and everolimus/other (5%). Sixty patients had second-line therapy including SSA alone (18%) or in combination (40%), cytotoxic chemotherapy (17%), everolimus (12%), LDT (7%), EBRT (3%), and other treatments (3%). Median time (months) to first-line discontinuation were as follows: SSAs, 43.3; cytotoxic chemotherapy, 3.6. Overall median time (months) to investigator-assessed progression following treatment initiation was 12.4. Median OS (months) following treatment initiation was 66.4 for all patients and 81.5 for patients receiving SSAs. Conclusion: SSAs, alone and in combination, are common treatments for advanced lung NETs. Patients have additional treatment options and relatively long survival compared with patients with other advanced cancers. Treatment pattern assessment following approval of newer treatments is needed. Implications for Practice: Somatostatin analogs (SSAs), cytotoxic chemotherapy, EBRT, liver-directed therapy, and targeted therapies are common treatments for locally advanced/metastatic (typical/atypical) lung neuroendocrine tumors (NETs). SSAs alone or in combination with other treatment modalities were the most common first- and second-line therapy, followed by cytotoxic chemotherapy. Patients continued treatment with SSAs long-term with median treatment duration of 43 months. Median overall survival was 66 months following initiation of first-line therapy for all patients. Treatment pattern assessment beyond the time period of this study is needed given recent U.S. Food and Drug Administration approvals for additional treatments for lung NETs that will likely be incorporated in the treatment landscape.

AB - Background: Using data from four tertiary referral centers in the U.S., we assessed real-world treatment patterns and clinical outcomes of patients with advanced lung neuroendocrine tumors (NETs). Subjects, Materials, and Methods: We performed a retrospective chart review of adult patients with locally advanced/metastatic (typical/atypical) lung NETs treated between July 2011 and December 2014. Index date was histologically confirmed typical/atypical carcinoid tumor diagnosis date. Data included baseline characteristics, treatment patterns, progression, death, and lung NET-related health care resource use from index date through last contact/death. Time to treatment discontinuation and first progression, time from first to second progression, and overall survival (OS) were estimated using Kaplan-Meier analysis. Results: We identified 83 patients; 19 (23%) had functional NET. First-line treatments included somatostatin analogs (SSAs) alone (56%) or in combination with other therapies (6%), cytotoxic chemotherapy (20%), external beam radiation therapy (EBRT) (9%), liver-directed therapy (LDT) (4%), and everolimus/other (5%). Sixty patients had second-line therapy including SSA alone (18%) or in combination (40%), cytotoxic chemotherapy (17%), everolimus (12%), LDT (7%), EBRT (3%), and other treatments (3%). Median time (months) to first-line discontinuation were as follows: SSAs, 43.3; cytotoxic chemotherapy, 3.6. Overall median time (months) to investigator-assessed progression following treatment initiation was 12.4. Median OS (months) following treatment initiation was 66.4 for all patients and 81.5 for patients receiving SSAs. Conclusion: SSAs, alone and in combination, are common treatments for advanced lung NETs. Patients have additional treatment options and relatively long survival compared with patients with other advanced cancers. Treatment pattern assessment following approval of newer treatments is needed. Implications for Practice: Somatostatin analogs (SSAs), cytotoxic chemotherapy, EBRT, liver-directed therapy, and targeted therapies are common treatments for locally advanced/metastatic (typical/atypical) lung neuroendocrine tumors (NETs). SSAs alone or in combination with other treatment modalities were the most common first- and second-line therapy, followed by cytotoxic chemotherapy. Patients continued treatment with SSAs long-term with median treatment duration of 43 months. Median overall survival was 66 months following initiation of first-line therapy for all patients. Treatment pattern assessment beyond the time period of this study is needed given recent U.S. Food and Drug Administration approvals for additional treatments for lung NETs that will likely be incorporated in the treatment landscape.

KW - Lung neuroendocrine tumor

KW - Real-world analysis

KW - Somatostatin analogs

KW - Treatment patterns

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