Cytotoxic chemotherapy

The precise role of traditional, cytotoxic chemotherapy in patients with metastatic neuroendocrine tumors remains controversial. Cytotoxic therapy appears to be most useful in patients with more aggressive, atypical neuroendocrine tumors. In such patients, treatment with regimens generally used for small cell carcinoma has been reported to be effective.

Metastatic Pancreatic Endocrine Tumors

Systemic chemotherapy with streptozocin and doxorubicin has been considered the standard treatment in patients with unresectable, metastatic disease. This combination has been reported to result in response rates as high as 69% in one randomized study of 105 patients. The true efficacy of this regimen has been question, however, due to the fact that both hormonal response and regression of hepatomegaly were included as response criteria in this study.

A retrospective review of patients with pancreatic islet cell carcinoma treated with streptozocin and doxorubicin at MSKCC failed to confirm this high response rate using standard radiologic criteria. In this study, only 1/16 patients achieved a partial response to therapy. Nevertheless, several patients in this study did achieve stabilization of disease and improvement in performance status, suggesting some benefit for this drug combination (Cheng et al, Cancer 1999; 86: 944-8)

Metastatic Carcinoid Tumors

There is less consensus about the optimal systemic treatment for patients with metastatic carcinoid tumors. Various combinations of streptozocin, 5-FU, doxorubicin, and DTIC have been reported to have some efficacy in this setting. There is no single “standard” regimen at this time.

[ back to top ]