Researchers from the UK have reported that a regimen of 5-FU, cisplatin, and streptozocin is an effective and tolerable regimen for treatment of newly diagnosed patients with neuroendocrine tumors. The details of this Phase II study were published early online on March 16, 2010 in the British Journal of Cancer.

Neuroendocrine tumors form from cells that release hormones in response to a signal from the nervous system. These tumors include carcinoid tumors, islet cell tumors, medullary thyroid carcinomas, pheochromocytomas, and Merkel cell carcinomas. Although they can occur in many different parts of the body, neuroendocrine tumors often develop in the digestive system. As a group, neuroendocrine tumors are generally resistant to chemotherapy. Management of neuroendocrine tumors requires an understanding of the disease process and a multimodality treatment approach involving surgery, radiation therapy, chemotherapy, and endocrine suppression.

This study included 79 patients with previously untreated neuroendocrine tumors who were treated in several medical centers in London. All received 5-FU, cisplatin, and streptozocin for up to six cycles administered every three weeks.

• The overall response rate was 33%, with stable disease occurring in 51%.

• The response rate was 38% for patients with pancreatic neuroendocrine tumors and 25% for other sites.

• Median time to progression was 9.1 months.

• Median survival was 31.5 months.

• Prognostic factors included Ki-67, mitotic index, grade, and chromogranin A.

• Response was predicted by mitotic index, grade alfa-fetoprotein.

• Neutropenia was common but infections were rare.

Comments: This regimen appears to be an acceptable regimen for the initial treatment of patients with neuroendocrine tumors. However, other agents are also active.

Reference: Turner NC, Strauss SJ, et al. Chemotherapy with 5-fluorouracil, cisplatin and streptozocin for neuroendocrine tumours. British Journal of Cancer [early online publication]. Mar 16, 2010.