Salvage Chemotherapy by FOLFIRI Regimen for Poorly Differentiated Gastrointestinal Neuroendocrine Carcinoma
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ORIGINAL RESEARCH
Salvage Chemotherapy by FOLFIRI Regimen for Poorly Differentiated Gastrointestinal Neuroendocrine Carcinoma Keiji Sugiyama 1 & Kazuhiro Shiraishi 1 & Mariko Sato 1 & Riko Nishibori 1 & Kazuki Nozawa 2 & Chiyoe Kitagawa 1 Accepted: 7 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Chemotherapy is the mainstay treatment for advanced poorly differentiated gastrointestinal neuroendocrine carcinoma (GI-NEC), with platinum-containing regimens being the optimal first-line regimen. However, the role and efficacy of second-line chemotherapy for GI-NEC are unclear. This study aimed to evaluate the feasibility and efficacy of fluorouracil, leucovorin, and irinotecan (FOLFIRI) as second-line therapy in patients with relapsed or recurrent GI-NEC after first-line platinum plus etoposide therapy. Methods We retrospectively evaluated eight consecutive patients with unresectable GI-NEC treated between 2017 and 2020. The inclusion criteria were pre-treatment with platinum doublet therapy, performance status (PS) 0–2, having measurable lesions, and treatment with FOLFIRI as second-line therapy. The overall response rate, progression-free survival (PFS), overall survival (OS), safety, and relative dose intensity were evaluated. Results Five patients met the inclusion criteria. Overall, 37 cycles of FOLFIRI were administered. The relative dose intensities for irinotecan, continuous infusion of 5-FU, and a bolus injection of 5-FU were 76%, 72%, and 54%, respectively. Overall, 2 of the 5 patients achieved partial response (40%), and the duration of response (DOR) was 4.0 months. The PFS and OS rates were 5.8 (95% CI, 1.5-NA) and 11 (95% CI, 6.3-NA) months, respectively. Overall, 4 of the 5 patients (80%) proceeded with further chemotherapy. Grade ≥ 3 adverse events except hematological toxicity included febrile neutropenia (n = 2), anorexia (n = 2), and fatigue (n = 1). Treatment discontinuation due to treatment-related adverse events was not observed. Conclusions FOLFIRI showed modest efficacy and feasibility for GI-NEC patients and has thus potential for patients who fail the first-line treatment. Keywords Poorly differentiated gastrointestinal neuroendocrine carcinoma . FOLFIRI . Retrospective study . Second-line chemotherapy
Introduction Gastrointestinal neuroendocrine carcinomas (GI-NECs) are a rare histological form of carcinoma [1]. In contrast to esophagogastric or colorectal adenocarcinoma, the treatment strategy for GI-NEC has not been established, and the
* Keiji Sugiyama [email protected] 1
Department of Medical Oncology, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, Aichi 460-0001, Japan
2
Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
prognosis is dismal. With respect to the treatment of advanced gastric or colorectal adenocarcinoma, sequential systemic therapies are crucial for prolonging overall survival (OS). Accordingly, second- and later-line chemotherapies hav
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