Chemotherapy for locally advanced and metastatic pulmonary carcinoid tumors

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.

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.

Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Figures

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) =

Fig. 2

Percentage survival for atypical carcinoid after development of metastatic disease. Ten of 27 patients presented with metastatic disease.