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Patients with carcinoid tumors which are not cured by surgery frequently suffer a prolonged, uncomfortable terminal course.Local recurrences or metastases are usually relatively slow-growing [18] and do not commonly produce rapid deterioration from biliary, renal or spinal fluid block. The patients usually present long-term management problems, testing the physician’s resources to control symptoms due to the pressure produced by the tumors and by the hormones which they release.

Chemotherapy in 400 patients during a 34-month period utilized 603 courses of therapy with 30 different agents. In 222 patients with measurable lesions, a 30-percent response rate was observed. Approximately ¼ of the responsive patients had complete responses, lasting up to 24 months, with a median complete response duration of 8 months. Of the 374 evaluable drug courses, 74 (20%) produced responses. Serious complications occurred in 45 patients, but only 3 drug-related deaths occurred. Of the 178 non-evaluable drug courses, 33 were administered prophylactically, as an adjuvant in patients with a poor prognosis. 82% of these patients remained alive and free of disease. 92 non-evaluable patients were treated for known but unmeasurable lesions; 34% of these patients remained alive. The other 49 non-evaluable patients received courses of therapy which were too short to permit evaluation. Of the common tumors, colo-rectal carcinoma and carcinoma of the breast were the most responsive to chemotherapy. The drugs which produced the highest percentage of responses in evaluable patients were 5-FU (24%), MTX (22%), ThioTEPA (21%) and DTIC (21 %), which appeared to be uniquely effective against malignant melanoma.

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