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. 2017 Jun 1;49(6):1601838.
doi: 10.1183/13993003.01838-2016. Print 2017 Jun.

Chemotherapy for pulmonary large cell neuroendocrine carcinomas: does the regimen matter?

Jules L Derks  1 , Robert Jan van Suylen  2 , Erik Thunnissen  3 , Michael A den Bakker  4   5 , Harry J Groen  6 , Egbert F Smit  7   8 , Ronald A Damhuis  9 , Esther C van den Broek  10 , Ernst-Jan M Speel  11   12 , Anne-Marie C Dingemans  13   12 ; PALGA group
Affiliations

Chemotherapy for pulmonary large cell neuroendocrine carcinomas: does the regimen matter?

Jules L Derks et al. Eur Respir J. .

Abstract

Pulmonary large cell neuroendocrine carcinoma (LCNEC) is rare. Chemotherapy for metastatic LCNEC ranges from small cell lung carcinoma (SCLC) regimens to nonsmall cell lung carcinoma (NSCLC) chemotherapy regimens. We analysed outcomes of chemotherapy treatments for LCNEC.The Netherlands Cancer Registry and Netherlands Pathology Registry (PALGA) were searched for patients with stage IV chemotherapy-treated LCNEC (2003-2012). For 207 patients, histology slides were available for pathology panel review. First-line platinum-based combined chemotherapy was clustered as "NSCLC-t", comprising gemcitabine, docetaxel, paclitaxel or vinorelbine; "NSCLC-pt", with pemetrexed treatment only; and "SCLC-t", consisting of etoposide chemotherapy.A panel review diagnosis of LCNEC was established in 128 out of 207 patients. NSCLC-t chemotherapy was administered in 46% (n=60), NSCLC-pt in 16% (n=20) and SCLC-t in 38% (n=48) of the patients. The median (95% CI) overall survival for NSCLC-t chemotherapy was 8.5 (7.0-9.9) months, significantly longer than patients treated with NSCLC-pt, with a median survival of 5.9 (5.0-6.9) months (hazard ratio 2.51, 95% CI 1.39-4.52; p=0.002) and patients treated with SCLC-t chemotherapy, with a median survival of 6.7 (5.0-8.5) months (hazard ratio 1.66, 95% CI 1.08-2.56; p=0.020).In patients with LCNEC, NSCLC-t chemotherapy results in longer overall survival compared to NSCLC-pt and SCLC-t chemotherapy.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

FIGURE 1
FIGURE 1
CONSORT (Consolidated Standards of Reporting Trials) diagram showing inclusion of patients and the performed pathology review. LCNEC: large cell neuroendocrine carcinoma; NSCLC NED: nonsmall cell lung carcinoma with immunohistochemically neuroendocrine differentiation; SCLC: small cell lung carcinoma; NET NOS: neuroendocrine tumour not otherwise specified; OS: overall survival; PFS: progression-free survival.
FIGURE 2
FIGURE 2
Overall survival in panel-consensus diagnosed large cell neuroendocrine carcinoma patients compared for a) chemotherapy clusters and b) subtypes of chemotherapy (excluding vinorelbine). n=128. NSCLC: nonsmall cell lung carcinoma regimen; SCLC: small cell lung carcinoma regimen.
FIGURE 3
FIGURE 3
Three multivariate models are presented for clustered chemotherapy, platinum–gemcitabine and platinum–paclitaxel chemotherapy in panel-consensus large cell neuroendocrine carcinoma. n=128. NSCLC: nonsmall cell lung carcinoma; SCLC: small cell lung carcinoma. #: excluding vinorelbine.
FIGURE 4
FIGURE 4
Progression-free survival compared for a) chemotherapy clusters and b) subtypes of chemotherapy (excluding vinorelbine) in panel-consensus large cell neuroendocrine carcinoma. n=119. NSCLC: nonsmall cell lung carcinoma chemotherapy regimen; SCLC: small cell lung carcinoma chemotherapy regimen.
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References

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