Management of controversial gastroenteropancreatic neuroendocrine tumour clinical situations with somatostatin analogues: results of a Delphi questionnaire panel from the NETPraxis programReportar como inadecuado




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BMC Cancer

, 16:858

Medical and radiation oncology

Abstract

BackgroundThere are clinical situations CS in which the use of somatostatin analogs SSAs in patients with neuroendocrine tumors NET is controversial due to lack of evidence. A Delphi study was conducted to develop common treatment guidelines for these CS, based on clinical practice and expert opinion of Spanish oncologists.

MethodsA scientific committee identified 5 CS with a common core c-c non-functioning NET, not susceptible of surgery-locoregional therapy, Ki67 < 10 % except for CS5: >10 %, ECOG ≤ 2, and controversy regarding use of SSAs, and prepared a Delphi questionnaire of 48 treatment statements. Statements were rated on a 1 completely disagree to 9 completely agree scale. Responses were grouped by tertiles: 1–3: Disagreement, 4–6: Neutral, 7–9: Agreement. Consensus was reached when the responses of ≥2-3 participants were located in the same tertile as the median value of all reported responses for that statement.

ResultsSixty five 81.2 % of 80 invited oncologists with experience in the management of NETs answered a first round of the questionnaire and 57 87.7 % of those 65 answered a second round mean age 43.5 years; 53.8 % women; median time of experience 9 years. Consensus was obtained in 42 36 agreement and 6 disagreement of the 48 statements 87.5 %. Regarding CS1 Enteropancreatic NET, c-c, non-progressive in the last 3–6 months, overall, SSA treatment is recommended a wait and see approach is anecdotal and reserved for fragile patients or with low tumor load or ki-67 < 2 %; CS2 Pancreatic NET, c-c, overall, SSA monotherapy is recommended, except when high tumor load or tumor progression exists, where combination therapy would be considered; CS3 Gastroenteropancreatic GEP-NET, c-c, in treatment with anti-proliferative dose of SSA and progressing, overall, SSA maintenance is recommended at the time of progression, with or without adding molecular targeted drugs; CS4 GEP-NET, c-c, and negative octreoscan®, SSA in monotherapy is only considered in low-risk patients low tumor load and Ki-67 < 5 %; CS5 GEP-NET, c-c ki67 > 10 %, and positive octreoscan®, monotherapy with SSA is mainly considered in patients with comorbidities.

ConclusionSeveral recommendations regarding use of SSAs in controversial NET CS were reached in consensus and might be considered as treatment guideline.

KeywordsNeuroendocrine tumors NET Gastroenteropancreatic NETs Somatostatin analogue SSA Delphi study AbbreviationsCSClinical situations

CαCronbach’s alpha

ECOGEastern Cooperative Oncology Group

GEPGastroenteropancreatic

kKappa index

MTDMolecular targeted drugs

NETNeuroendocrine tumor

riIntra-class correlation coefficient

rsSpearman coefficient

SSASomatostain analogue

VCVariation coefficient

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Autor: Isabel Sevilla - Ángel Segura - Jaume Capdevila - Carlos López - Rocío García-Carbonero - Enrique Grande - On behalf of

Fuente: https://link.springer.com/







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