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pts. Poorly differentiated endocrine carcinoma (PDEC). Age (median) 54 a. (r
18-84). Primary Location: small intestine 40, pancreas 26 pts. Appendix 9 pts.,
Stomach 8, rectum 6, unknown 6, colon 4, and esophagus 1 pte. Metastatic disease
76 pts., Localized disease in 24 pts. The expression of SSTR was: Subtype 2 (positive
80 pts.) and subtype 5 (positive 46 pts.). Ki 67 was less than or equal to 2% in 36
pts., between 3 and 15%, 49 pts. and more than 15% in 12 pts. 26/100 pts. had
functioning tumors. The analysis included 55 pts. with SSTR 2 / 5 pos. Ki 67 less
than or equal to 2% (Group 1), 38 pts. with SSTR 2 / 5 pos and Ki 67 more than 2%
(Group 2), 5 pts. with SSTR 2 / 5 neg. Ki 67 less than or equal to 2% (Group 3) and
2 pts. with SSTR 2 / 5 neg and Ki 67 more than 2% (Group 4). Univariate analysis
showed significant differences for the expression of SSTR 2 (p. 009), and Ki 67
(p. 001). Survival was higher in Group 1 versus Group 2, median OS was 97 months
vs 49 months, and 36 to 23 months, in groups 3 and 4 respectively (p. 0001).
Conclusions: In this population of pts with GEP-NET we could identify a subgroup
of better prognosis associated with expression of SSTR 2 / 5 and Ki 67 less than or
equal to 2%. The assessment of SSTR 2 and 5 in tissue, and proliferative index are
useful tools for evaluating prognosis in this setting.
Disclosure: All authors have declared no conflicts of interest.
1165P EFFICACY AND SAFETY OF SOMATULINE AUTOGEL IN
COMBINATION WITH MOLECULAR TARGETED THERAPIES
(MTT) IN NEUROENDOCRINE TUMORS (NETS)
J. Capdevila 1 , I. Sevilla 2 , V. Alonso 3 , L. Anton-Aparicio 4 , P. Jimenez Fonseca 5 ,
E. Grande 6 , J.J. Reina 7 , J.L. Manzano 8 , J. Alonso-Jara 9 , P. García Alfonso 10
1 Medical Oncology, Vall d’Hebron University Hospital, Barcelona, SPAIN,
2 Medical Oncology, Virgen de la Victoria University Hospital, Malaga, SPAIN,
3 Medical Oncology, Miguel Servet University Hospital, Zaragoza, SPAIN,
4 Medical Oncology, Complejo Hospitalario A Coruña, A Coruña, SPAIN, 5 Medical
Oncology, Hospital Universitario Central de Asturias, Oviedo, SPAIN, 6 Medical
Oncology, Ramon y Cajal University Hospital, Madrid, SPAIN, 7 Medical
Oncology, Virgen de la Macarena University Hospital, Sevilla, SPAIN, 8 Medical
Oncology, ICO Hospital Germans Trias i Pujol, Barcelona, SPAIN, 9 Medical
Oncology, Virgen de la Arrixaca University Hospital, Murcia, SPAIN, 10 Medical
Oncology, Gregorio Marañón University Hospital, Madrid, SPAIN
Background: Analysis of the mechanisms of action of somatostatin analogs (SSAs)
and mTOR inhibitors or multiple tyrosine kinase inhibitors have suggested that they
may provide synergistic effects when used in combination for the treatment of
patients with NETs.
Methods: This is a Spanish Multicenter cohort of patients (pts) with NETs treated
with the SSAs lanreotide (LAN) and MTTs at 35 Spanish Medical Oncology
Departments. The data of 159 combined treatments (133 pts) was retrospectively
collected in order to evaluate the efficacy and safety of such combinations out of trials.
Results: 133 pts (52,6% Male) with a mean age of 59,4 years; ECOG 0/1/2/3: 34%/
49%/16%/1%; Lung/Pancreas/Gastrointestinal//Unknown(UK)origin: 9%/48% /32%/
11%; G1/G2/G3/UK: 41%/32%/1%/26%; Non Functioning/ Functioning (69%/31%)
received treatment with MTT + LAN for synergistic antiproliferative purpose in 85%
of the cases, hormonal control (13,5%) or both objectives (1,5%). 115 pts received
just one and 18 pts received between 2 (12 pts) and 5 (1 pt) combination treatments.
LAN was administrated in combination with everolimus (46%), sunitinib (38%),
bevazucimab (6%), sorafenib (5%) and pazopanib (5%). The reported toxicity was
determined by the MTT profile with no significant additional severe adverse events
related to the combination with LAN. The median progression-free survival (mPFS)
for the two main groups was 31.9 months for those pts who received LAN and
sunitinib (n = 50) and 21.9 months for those pts who received LAN and everolimus
(n = 56).
Conclusions: The combination of LAN and MTT treatments, mainly everolimus and
sunitinib, is widely used in clinical practice without unexpected toxicities. Although
studies are not directly comparable mPFS observed in the two main groups were
higher than data showed by phase III studies with sunitinib, everolimus or SSAs
alone raising the hypothesis of enhanced antitumor efficacy combining SSAs and
MTT that should be confirmed in randomized prospective clinical trials.
Tumor Response (%)
Nº PD SD PR CR Not evaluated
61 Sunit +LAN 4.9 68.9 14.8 1.6 9.8
73 Evero +LAN 12.3 67.0 15.1 0 5.5
9 Bevac +LAN 0 88.9 11.1 0 0
8 Soraf +LAN 0 100.0 0 0 0
8 Pazop +LAN 12.5 75.0 12.5 0 0
Disclosure: All authors have declared no conflicts of interest.
Annals of Oncology
1166P AWARENESS OF THE CLINICAL PRESENTATION AND
DIAGNOSIS OF NEUROENDOCRINE TUMOURS IN AN
AUSTRALIAN GENERAL PHYSICIAN POPULATION
J.C. Leyden
Anaesthesia, Royal North Shore Hospital, St Leonards, NSW, AUSTRALIA
Background: Neuroendocrine Tumours (NETs) are a rare group of malignancies
where the correct diagnosis is often delayed for many years resulting in local and
distant spread of the disease and mean 5 year survival rate of 30%. The diagnosis
of NETs is challanging and requires the expertise of many medical specialists and
diagnostic modalities. The General Physician (GP) is pivotal for early recognition,
referral and management of this disease. The Unicorn Foundation, Australia’s only
charity directed to NET patient support, advocacy and research conducted a
survey of Australian Physicians to determine knowledge of NETs. A secondary
objective of the survey was to raise awareness of the disease in a broad medical
population.
Methods: 9952 registered medical practitioners received an introductory email
requesting participation in the online “NET Awareness Survey”. The questions were
presented as ‘best answer’ multiple choice format with the ability to choose ‘not sure’
as an option. 26 questions covering basic NET epidemiology, clinical pathology and
presentation, diagnosis and referral pattern were included.
Results: The survey was open from July 2011 until December 2011. A population of
9552 registered medical practitioners received the email; 38% (3630) ‘opened’ the
email and 7% (655) completed the survey. Of the survey respondants, 65% (425)
were General Physicians. The results of the survey indicated a lack of awareness/
knowledge regarding NET epidemiology; pathology; spectrum of disease (including
metastatic potential) and use of Chromogranin A as a biomarker of the disease. The
majority of the respondants acknowledged the difficulties of diagnosis; the myriad
presenting symptoms and association of NETs with familial syndromes.
Conclusion: The survey results showed that a significant proportion of General
Physicians had minimal knowledge of Neuroendocrine Tumours (NETs) and their
behaviour and there was a general misunderstanding of appropriate investigations to
facilitate diagnosis. Improved awareness of the NETs and investigative strategies to
improve diagnosis are needed amongst medical practitioners especially those in
general practice.
Disclosure: J.C. Leyden: This research project has been supported by unrestricted
educational grant from Novartis Oncology, Ipsen Pharmaceutical and Pfizer
Pharmaceutical.
1167P NEUROENDOCRINE TUMORS: A REVIEW OF THE
SUNNYBROOK ODETTE CANCER CENTRE DATABASE
J. Craig 1 , M. Cheung 2 ,C.Law 3 , S. Singh 4
1 Medical Oncology, Sunnybrook Odette Cancer Center, Toronto, ON, CANADA,
2 Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre,
Toronto, ON, CANADA, 3 Surgical Oncology, Odette Cancer Centre, Sunnybrook
Health Sciences Centre, Toronto, ON, CANADA, 4 Medical Oncology, Odette
Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, CANADA
Background: Neuroendocrine tumors (NETs) are an uncommon and heterogeneous
group of malignancies. A number of reviews have been published attempting to
better identify factors of important prognostic significance in predicting overall
survival, however these studies are often limited by small sample size and were
published before new therapy options came into widespread use. AIMS: We reviewed
our experience at our NETs multidisciplinary reference centre in the management of
NETs to attempt to identify important patient and tumor characteristics associated
with improved overall survival.
Methods: The Sunnybrook Odette Cancer Centre NETs Database was retrospectively
reviewed. All patients with a pathologically confirmed diagnosis of NET were
included in the analysis. Patient characteristics, tumor markers and pathology,
treatment, and response to treatment were recorded. Univariate and multivariate
Cox-regression analyses were performed.
Results: A total of 327 patients were included in the analysis. Mean age at presentation
was 55.6 years. A total of 159 (48.6%) patients were male. The most common primary
site was small bowel (34.3%), followed by pancreas (21.1%) and large bowel/rectum/
anus (11.9%). In univariate analysis, factors associated with improved overall survival
included local/regional disease at presentation (p < 0.001), lower Ki67 index
(p < 0.001), normal chromogranin A at presentation (p = 0.008), urinary
5-Hydroxyindoleacetic acid drop following treatment (p = 0.024), symptom response to
treatment (p < 0.001), surgery on the primary tumor (p < 0.001), surgery on metastases
(p = 0.003), having multiple surgeries (p < 0.001), and treatment with long-acting
somatostatin (LAS) (p = 0.029). In multivariate analysis, treatment with LAS (p <
0.001, HR 0.141, 95%CI 0.064-0.31) and having multiple surgeries (p = 0.045, HR
0.591, CI 0.354-0.988) were shown to be independent predictors of improved overall
survival.
ix380 | Abstracts Volume 23 | Supplement 9 | September 2012