Neuroendocrine tumors require individualized treatment approach
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Patients with neuroendocrine tumors are at greater risk for cancer-associated death compared with death due to other causes; however, mortality rates vary according to tumor site.
The results, published in Journal of the National Comprehensive Cancer Network, indicate that neuroendocrine tumors are heterogenous and treatment should be tailored individually, according to Julie Hallet, MD, MSc, FRCSC, researcher in the department of surgery at Odette Cancer Centre at Sunnybrook Health Sciences Center in Toronto.
“Neuroendocrine tumors are an uncommon type of cancer and are unique in that they are slow growing, which means that patients can live for years with this tumor type even if it has spread to more than one organ,” Hallet told Healio. “With a slow-growing tumor, understanding what risk the cancer presents to a patient’s life is crucial. However, we did not have such information. Therefore, we aimed to describe cancer-specific deaths for patients diagnosed with neuroendocrine tumors to help with patient counseling and weigh the risks in making treatment plans.”
The study included 8,607 adults (50.2% women) diagnosed with neuroendocrine tumors between 2001 and 2015. Most patients had bronchopulmonary (22.8%), small intestine (19.3%) and rectal (14.4%) neuroendocrine tumors. Overall, 42.2% of patients had metastases, of which 32% were synchronous metastases.
Researchers used competing risks methods to estimate the cumulative incidence of cancer-specific and noncancer deaths categorized by primary neuroendocrine tumor site and metastatic status. Prognostic factors were assessed with subdistribution hazard models.
At median follow-up of 42 months, 3,121 (36.3%) of patients had died, including 2,487 due to cancer.
The 5-year risk for cancer-specific death was 27.3% (95% CI, 26.3-28.4) vs. 5.6% (95% CI, 5.1-6.1) for noncancer death. OS among all patients was 67.1% (95% CI, 66-68.1) at 5 years and 55.1% (95% CI, 53.6-56.6) at 10 years.
Patients with bronchopulmonary neuroendocrine tumors had the highest risk for cancer-associated death, with rates of 36.4% (95% CI, 34.2-38.7) at 5 years and 42.7% (95% CI, 0.1-45.3) at 10 years, followed by pancreatic neuroendocrine tumors with a 34.8% (95% CI, 31.5-38.2) risk at 5 years and a 48.4% (95% CI, 43.5-53) risk at 10 years, and rectal neuroendocrine tumors with a 21.4% (95% CI, 18.9-24) risk at 5 years and a 26.6% (95% CI, 23.4-29.9) risk at 10 years.
Factors independently associated with a higher risk for cancer-associated mortality included advancing age, higher material deprivation and metastases, whereas women and those with a higher comorbidity burden had a lower risk for cancer-associated death.
“Overall, our results provide important information for individual patient counseling and tailored management,” Hallet said. “For patients with metastatic neuroendocrine tumors, we provide estimates of the risk of cancer-specific death for metastatic neuroendocrine tumors, which can be useful to counsel patients about what to expect. This is important because often when people hear stage IV or metastatic cancer, they immediately think the cancer is going to kill them quickly. It is not the case for neuroendocrine tumors.
“We can now provide patients with estimates to help them understand and make plans moving forward,” Hallet added “Most importantly, we also showed that some patients with nonmetastatic neuroendocrine tumors are more likely to die of other causes than neuroendocrine tumors. This is crucial to inform patients and make decisions regarding treatment.”
Hallet and colleagues are now examining how the information on cancer-specific survival can be used to assess therapeutic choices for patients with neuroendocrine tumors.
“Many studies on neuroendocrine tumors focus on recurrence and PFS or OS, but with an indolent cancer, it would be useful to know how different treatments impact cancer-specific survival,” Hallet said. “Also, because patients with neuroendocrine tumors live for a long time after diagnosis, they are also at risk for having other cancers diagnosed afterward. My team is also looking at how often patients with neuroendocrine tumors get a second cancer and whether that second cancer impacts cancer-specific death. This would have implications in screening for second cancers after diagnosis of neuroendocrine tumors.”
For more information:
Julie Hallet, MD, MSc, FRCSC, can be reached at Odette Cancer Centre at Sunnybrook Health Sciences Center, 2075 Bayview Ave., T2-102, Toronto, Ontario M4N 3M5, Canada; email: julie.hallet@sunnybrook.ca.
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