Prolonged progression‐free survival achieved by octreotide LAR plus transarterial embolization in low‐to‐intermediate grade neuroendocrine tumor liver metastases with high hepatic tumor burden

Abstract

Objective To evaluate the efficacy and outcome of transarterial embolization (TAE) plus octreotide long‐acting repeatable (LAR) on patients with low‐to‐intermediate neuroendocrine tumor liver metastases (NETLM). Methods One hundred and sixteen patients with G1/G2 NETLM treated with TAE plus octreotide LAR at the First Affiliated Hospital, Sun Yat‐sen University between January 12, 2016 and September 24, 2020 were reviewed. Radiological response was evaluated according to response evaluation criterion in solid tumor version 1.1. Overall progression‐free survival (PFS) was assessed. Intrahepatic and extrahepatic PFS were evaluated in the whole cohort and in patients with the extrahepatic disease (EHD), respectively. Factors affecting treatment response and overall PFS were analyzed using the logistic regression model and Cox proportional hazard model. Adverse events were recorded and evaluated according to Common Terminology Criteria for Adverse Events 5.0. Results The median overall PFS of the whole cohort was 13.6 months. For the patients with EHD, the median intrahepatic PFS and extrahepatic PFS were 13.6 and 26.1 months, respectively. The median overall PFS of patients with hepatic tumor burden (HTB) <10%, 10%–25%, 25%–50%, and >50% were 25.2, 13.6, 11.2, and 12.3 months, respectively. Ki67 >10%, HTB >50%, and bone metastasis were independently associated with overall PFS. The objective response rate was 78.4%. In patients with HTB 25%–50% and >50%, responders (complete response or partial response) had significant prolonged PFS compared with nonresponders (stable disease or progression disease). Ki67 >10%, bone metastasis, and clear tumor margin were independently associated with response to TAE. The most frequent adverse events that occurred after TAE were postembolization syndrome, and no treatment‐associated death occurred during the perioperative period. Conclusion Transarterial embolization plus octreotide LAR can significantly prolong the PFS of neuroendocrine tumor liver metastases, especially with high HTB over 50%. Selected patients with HTB >25% (ki67 ≤10%, absence of bone metastasis, clear tumor margin) could derive prognostic advantage from the combined treatment.

Using percutaneous computed tomography-guided core needle biopsy of liver metastases from gastroenteropancreatic neuroendocrine tumors to identify inter-tumor grading classification heterogeneity

“…However, well-differentiated G2 GEP NET changes may advance to G3 tumors which are morphologically differentiated and may require other therapeutic strategies (29). Several strategies are available for the clinical management of liver metastases in GEP NET (17) and range from surgery to ablation with various interventional radiology procedures (30,31), including regional and systemic therapy with varied cytotoxic, biological, or targeted agents (32)(33)(34)(35). Therefore, it is plausible that PCT-CNB analysis of liver metastases provides comprehensive insights for therapeutic GEP NET decision-making.…”

Application of interventional therapy via hepatic artery in pancreatic neuroendocrine neoplasms liver metastases

“…The methods of interventional therapy via hepatic artery for pancreatic neuroendocrine neoplasm liver metastases include transhepatic artery embolization (TAE), transhepatic artery chemoembolization (TACE), transhepatic artery radioembolization (TARE), and hepatic artery infusion chemotherapy (HAIC). [11][12][13][14][15][16][17][18] The effect was quite reliable. The ORR was approximately 33% to 82%, [12,15,20] PFS was about 16.1 to 28 months, [14,21] 5-year survival rate was about 11.1% to 57%, [15,22] and median over survival (OS) period was approximately 34.9 to 87.4 months.…”

“…[11][12][13][14][15][16][17][18] The effect was quite reliable. The ORR was approximately 33% to 82%, [12,15,20] PFS was about 16.1 to 28 months, [14,21] 5-year survival rate was about 11.1% to 57%, [15,22] and median over survival (OS) period was approximately 34.9 to 87.4 months. In recent years, the clinical trials of intraarterial PRRT (IA-PRRT) was ongoing, [23][24][25] and the preliminary data was promising.…”

“…PNENLM usually present as hypervascularity lesions with the main blood supply coming from the hepatic artery. [10] Lots of studies have shown that intraarterial therapy of PNENLM via hepatic artery could reduce the HTB of type III liver metastases, improve objective response ratio (ORR), prolong progression-free survival (PFS) effectively, [11][12][13][14][15][16][17][18] and relieve hormone-related symptoms significantly. [19] The original site of pancreatic neuroendocrine neoplasm could be the head, body, and tail of the pancreas with different prognoses.…”

Case Report: Octreotide plus CVD chemotherapy for the treatment of multiple metastatic paragangliomas after double resection for functional bladder paraganglioma and urothelial papilloma

“…Octreotide is a somatostatin analog (SSA) that suppresses the proliferation of NETs through specifically binding to somatostatin receptors (SSTRs) and alleviates the clinical manifestations of metastatic PPGLs (8). Octreotide long-acting repeatable (LAR) has been recommended to potentially control tumor growth in patients with metastatic neuroendocrine midgut tumors based on the PROMID studies (9,10).…”