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. 2014 Nov;86(2):241-6.
doi: 10.1016/j.lungcan.2014.08.012. Epub 2014 Aug 27.

Chemotherapy for locally advanced and metastatic pulmonary carcinoid tumors

Curtis R Chong  1 , Lori J Wirth  2 , Mizuki Nishino  3 , Aileen B Chen  4 , Lynette M Sholl  5 , Matthew H Kulke  6 , Ciaran J McNamee  7 , Pasi A Jänne  8 , Bruce E Johnson  9
Affiliations

Chemotherapy for locally advanced and metastatic pulmonary carcinoid tumors

Curtis R Chong et al. Lung Cancer. 2014 Nov.

Abstract

Objectives: The optimal management of locally advanced and metastatic pulmonary carcinoid tumors remains to be determined.

Materials and methods: A retrospective review was conducted on patients with typical and atypical pulmonary carcinoid tumors treated at our institutions between 1990 and 2012.

Results: 300 patients were identified with pulmonary carcinoid, (80 patients with atypical carcinoid), of whom 29 presented with metastatic disease (16 atypical). Of evaluable patients, 26 (41%) with stages I-III atypical carcinoid tumors recurred at a median time of 3.7 years (range, 0.4-32), compared to 3 (1%) patients with typical carcinoid (range, 8-12.3). 39 patients were treated with chemotherapy, including 30 patients with metastatic disease (27 atypical), and 7 patients were treated with adjuvant platinum-etoposide chemoradiation (6 atypical, 1 typical, 6 stage IIIA, 1 stage IIB). At a median follow-up of 2 years there were 2 recurrences in the 7 patients receiving adjuvant treatment. Median survival after diagnosis of metastatic disease for patients with atypical pulmonary carcinoid was 3.3 years with a 5-year survival of 24%. Treatment regimens showing efficacy in pulmonary carcinoid include 15 patients treated with octreotide-based therapies (10% response rate (RR), 70% disease control rate (DCR), 15 month median progression-free survival (PFS)), 13 patients treated with etoposide+platinum (23% RR, 69% DCR, 7 month median PFS), and 14 patients treated with temozolomide-based therapies (14% RR, 57% DCR, 10 month median PFS). 8 of 10 patients with octreotide-avid disease treated with an octreotide-based regimen experienced disease control (1 partial response, 7 stable disease) for a median of 18 months (range 6-72 months).

Conclusions: These results support our previous finding that a subset of pulmonary carcinoid tumors are responsive to chemotherapy.

Keywords: Atypical carcinoid; DIPNECH; Typical carcinoid.

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Conflict of interest statement

Conflicts of interest

The authors declare no conflicts of interest related to the work presented in this manuscript.

Bruce E. Johnson reports the following interests:

  1. Genzyme (post-market royalties for EGFR mutation testing).

  2. Consulting for Genentech, Pfizer, Chugai, Acceleron, Astra Zeneca, Millenium, Kew, Transgenomic, Veridex, and Teva.

Figures

Fig. 1
Fig. 1
(A) Time to recurrence for patients with atypical carcinoid tumors. Comparison of time to recurrence between atypical carcinoid patients (by stage) and typical carcinoid patients. p-Value for comparison of recurrence between atypical carcinoid (any stage) and typical carcinoid (any stage) = <0.001 (Log-Rank). (B) Percentage alive of patients with atypical tumors by stage at initial presentation as measured from date of initial diagnosis.
Fig. 2
Fig. 2
Percentage survival for atypical carcinoid after development of metastatic disease. Ten of 27 patients presented with metastatic disease.
See this image and copyright information in PMC

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