Appropriateness of systemic treatments in unresectable metastatic well-differentiated pancreatic neuroendocrine tumors

Table 9 Third-line treatment in patients with unresectable metastatic well-differentiated pancreatic neuroendocrine tumors

Rate the appropriateness of the following as a third-line medical treatment in a patient who has had an adequate trial of two agents, one of which was a somatostatin analogue. Assume for each question that the agent being rated was not previously used	In a patient whose primary problem is:
	Uncontrolled secretory symptoms	Uncontrolled tumor-related symptoms	Rapid radiographic progression	Nonrapid radiographic progression	No symptoms and no radiographic progression
Higher dose/frequency of somatostatin analogue (e.g., > 30 mg dose or < 4 wk dosing of octreotide LAR)	9.03 (0.4)	3.01 (1.6)	2.51 (1.0)	4.52 (1.8)	1.01 (0.4)
Everolimus	9.03 (0.7)	9.03 (0.7)	8.03 (0.8)	7.03 (0.6)	1.01 (0.7)
Sunitinib	8.53 (0.7)	9.03 (0.7)	8.03 (0.8)	7.03 (0.7)	1.01 (0.7)
Interferon	5.02 (0.9)	4.52 (1.3)	4.02 (1.0)	3.01 (1.7)	1.01 (0.4)
Temozolomide-containing regimen	7.53 (1.4)	7.53 (1.2)	7.53 (1.5)	5.02 (1.3)	1.01 (0.6)
Streptozotocin-containing regimen	5.52 (1.3)	7.03 (1.4)	6.53 (1.2)	4.52 (1.6)	1.01 (0.4)
Cytotoxic Chemotherapy	6.53 (1.3)	8.03 (1.1)	8.03 (1.2)	5.52 (1.5)	1.01 (0.9)

The medians of ratings represents the type of panel consensus that was reached for the particular patient scenario (cell):

¹Median rating 1-3 and no disagreement⁴ = “inappropriate”;

²Median rating 4-6 and no disagreement⁴ = “uncertain”; and

³Median rating 7-9 and no disagreement⁴ = “appropriate”; ⁴ > 2 responses in the range 1-3 and > 2 responses in the range 7-9 = “disagreement”.