Published online Sep 7, 2017. doi: 10.3748/wjg.v23.i33.6128
Peer-review started: February 9, 2017
First decision: April 21, 2017
Revised: May 9, 2017
Accepted: June 18, 2017
Article in press: June 19, 2017
Published online: September 7, 2017
Processing time: 210 Days and 6.3 Hours
To describe real-world treatment patterns of gastrointestinal neuroendocrine tumors (GI NET).
In this retrospective cohort study, we used 2009-2014 data from 2 United States commercial claims databases to examine newly pharmacologically treated patients using tabular and graphical techniques. Treatments included somatostatin analogues (SSA), cytotoxic chemotherapy (CC), targeted therapy (TT), interferon (IF) and combinations. We identified patients at least 18 years of age, with ≥ 1 inpatient or ≥ 2 outpatient claims for GI NET who initiated pharmacologic treatment from 7/1/09-6/30/14. A 6 mo clean period prior to first treatment ensured patients were newly treated. Patients were followed until end of enrollment or the study end date, whichever was first.
We identified 2258 newly treated GI NET patients: mean (SD) age was 55.6 years (SD = 9.7), 47.2% of the patients were between 55 and 64 years, and 48.8% were female. All regions of the United States were represented. 59.6% started first-line therapy with SSA monotherapy (964 with octreotide LAR, 380 with octreotide SA, and 1 with lanreotide), 33.3% CC, 3.6% TT, and 0.5% IF. The remainder received combinations. Mean follow up was 576 d. Overall mean first-line therapy duration was 361 d (449 d for SSA, 215 for CC, 267 for TT). 58.9% of patients had no pharmacological treatment beyond first line. The most common second-line was combination therapy with SSA. In graphical pattern analysis, there was no clear pattern visible after first line therapy.
In this study, 60% of patients initiated treatment with SSA alone or in combination. The relatively long time to discontinuation suggests possible sustained effectiveness and tolerability.
Core tip: In this retrospective study of real-world treatment patterns, somatostatin analogues were the most common initial pharmacologic treatment in patients with gastrointestinal neuroendocrine tumors, and most of the remaining patients began treatment with chemotherapy. However, despite the many treatment options, over half of the patients discontinued treatments after first line and only less than 10% of patients received any second-line pharmacotherapy. Given limitations of claims data to elucidate reasons for this lack of continued treatment, a study using more detailed clinical information such as medical charts or physician surveys is warranted.