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Selection of Chemotherapy in Advanced Poorly Differentiated Extra-Pulmonary Neuroendocrine Carcinoma.
- Source :
-
Cancers . Oct2023, Vol. 15 Issue 20, p4951. 13p. - Publication Year :
- 2023
-
Abstract
- Simple Summary: Extra-pulmonary poorly differentiated neuroendocrine carcinoma is a rare tumour type with a limited evidence base for its treatment. Recent work has helped to clarify the optimum first-line chemotherapy regimen. However, in the second-line setting, data remain sparse. A more personalised approach is warranted, given the heterogeneity of this disease, and emerging translational approaches focused on mouse models, organoids, and comprehensive genomic profiling may guide future trial design. Extra-pulmonary poorly differentiated neuroendocrine carcinoma is rare, and evidence for treatment has been limited. In this article, the evidence behind the cytotoxic chemotherapy choices used for metastatic or unresectable EP-PD-NEC is reviewed. In the first-line setting, etoposide and platinum chemotherapy or irinotecan and platinum have been demonstrated to be equivalent in a large phase III trial. Questions remain regarding the optimal number of cycles, mode of delivery, and the precise definition of platinum resistance in this setting. In the second-line setting, FOLFIRI has emerged as an option, with randomized phase 2 trials demonstrating modest, but significant, response rates. Beyond this, data are extremely limited, and several regimens have been used. Heterogeneity in biological behaviour is a major barrier to optimal EP-PD-NEC management. Available data support the potential role of the Ki-67 index as a predictive biomarker for chemotherapy response. A more personalised approach to management in future studies will be essential, and comprehensive multi-omic approaches are required to understand tumour somatic genetic changes in relation to their effects on the surrounding microenvironment. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 20726694
- Volume :
- 15
- Issue :
- 20
- Database :
- Academic Search Index
- Journal :
- Cancers
- Publication Type :
- Academic Journal
- Accession number :
- 173269019
- Full Text :
- https://doi.org/10.3390/cancers15204951