Real-world treatment patterns of gastrointestinal neuroendocrine tumors: A claims database analysis

doi:10.3748/wjg.v23.i33.6128

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World Journal of Gastroenterology

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Retrospective Cohort Study

World J Gastroenterol. Sep 7, 2017; 23(33): 6128-6136
Published online Sep 7, 2017. doi: 10.3748/wjg.v23.i33.6128

Table 1 Patient demographics by first-line treatment n (%)

	First-line treatment									All newly treated patients
	SSA	CC	TT	SSA + CC	SSA + TT	TT + CC	IF	SSA + IF	SSA + TT + CC	All newly treated patients
n	1345¹	752	81	42	31	3	2	1	1	2258
	59.6%	33.3%	3.6%	1.9%	1.4%	0.1%	0.1%	0.0	0.0	100.0%
Age (mean ± SD, yr)	56.3 ± 9.5	54.7 ± 9.9	54.9 ± 10.5	53.5 ± 10.9	53.8 ± 10.1	59.3 ± 3.8	58.5 ± 3.5	N/A	N/A	55.6 ± 9.7
18-24	6 (0.4)	2 (0.3)	0 (0)	1 (2.4)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	9 (0.4)
25-34	20 (1.5)	25 (3.3)	4 (4.9)	3 (7.1)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	52 (2.3)
35-44	121 (9.0)	92 (12.2)	9 (11.1)	4 (9.5)	4 (12.9)	0 (0)	0 (0)	0 (0)	0 (0)	230 (10.2)
45-54	371 (27.6)	225 (29.9)	18 (22.2)	12 (28.6)	12 (38.7)	0 (0)	0 (0)	0 (0)	0 (0)	638 (28.3)
55-64	651 (48.4)	338 (44.9)	39 (48.1)	20 (47.6)	11 (35.5)	3 (100.0)	2 (100.0)	1 (100.0)	1 (100.0)	1066 (47.2)
65+	176 (13.1)	70 (9.3)	11 (13.6)	2 (4.8)	4 (12.9)	0 (0)	0 (0)	0 (0)	0 (0)	263 (11.6)
Female	677 (50.3)	341 (45.3)	40 (49.4)	26 (61.9)	17 (54.8)	1 (33.3)	1 (50.0)	0 (0.0)	0 (0.0)	1103 (48.8)
Region
Midwest	321 (23.9)	183 (24.3)	20 (24.7)	13 (31.0)	7 (22.6)	0 (0)	1 (50.0)	0 (0)	0 (0)	545 (24.1)
Northeast	261 (19.4)	150 (19.9)	12 (14.8)	11 (26.2)	7 (22.6)	1 (33.3)	0 (0)	0 (0)	0 (0)	442 (19.6)
South	563 (41.9)	323 (43.0)	36 (44.4)	12 (28.6)	15 (48.4)	2 (66.7)	1 (50.0)	0 (0)	1 (100.0)	953 (42.2)
West	200 (14.9)	96 (12.8)	13 (16.0)	6 (14.3)	2 (6.5)	0 (0)	0 (0)	1 (100.0)	0 (0)	318 (14.1)
Year of treatment initiation	130 (9.7)	41 (5.5)	4 (4.9)	2 (4.8)	1 (3.2)	0 (0)	0 (0)	1 (100.0)	0 (0)	179 (7.9)
2009	130 (9.7)	41 (5.5)	4 (4.9)	2 (4.8)	1 (3.2)	0 (0)	0 (0)	1 (100.0)	0 (0)	179 (7.9)
2010	271 (20.1)	122 (16.2)	4 (4.9)	11 (26.2)	7 (22.6)	0 (0)	1 (50.0)	0 (0)	0 (0)	416 (18.4)
2011	282 (21.0)	159 (21.1)	15 (18.5)	17 (40.5)	5 (16.1)	0 (0)	0 (0)	0 (0)	0 (0)	478 (21.2)
2012	270 (20.1)	168 (22.3)	33 (40.7)	4 (9.5)	10 (32.3)	0 (0)	1 (50.0)	0 (0)	1 (100.0)	487 (21.6)
2013	268 (19.9)	174 (23.1)	16 (19.8)	3 (7.1)	4 (12.9)	2 (66.7)	0 (0)	0 (0)	0 (0)	467 (20.7)
2014	124 (9.2)	88 (11.7)	9 (11.1)	5 (11.9)	4 (12.9)	1 (33.3)	0 (0)	0 (0)	0 (0)	231 (10.2)
Days of follow-up
Mean	621	514	454	588	425	244	675	836	496	576
(SD)	(468.5)	(409.1)	(403.6)	(424.1)	(269.6)	(140.7)	(145.7)	N/A	N/A	(447.1)
Median	500	393	290	455	360	216	675	836	496	454

¹964 with octreotide LAR, 380 with octreotide SA, and 1 with lanreotide. SSA: Somatostatin analogues; CC: Cytotoxic chemotherapy; TT: Targeted therapy; IF: Interferon.

Table 2 Use of first-line treatment n (%)

	First-line									All newly treated patients
	SSA	CC	TT	SSA + CC	SSA + TT	TT + CC	IF	SSA + IF	SSA + TT + CC	All newly treated patients
n	1345	752	81	42	31	3	2	1	1	2258
n	59.6%	33.3%	3.6%	1.9%	1.4%	0.1%	0.1%	0.0%	0.0%	100.0%
Duration of first-line treatment (mean ± SD, d)	449 ± 434.2	215 ± 228.8	267 ± 325.7	408 ± 327.9	276 ± 189.5	208 ± 165.6	251 ± 285.0	836 ± 0	426 ± 0	361 ± 385.0
First-line ending status	635 (47.2)	609 (81.0)	44 (54.3)	26 (61.9)	14 (45.2)	1 (33.3)	1 (50.0)	0 (0)	1 (100.0)	1331 (58.9)
Stop	635 (47.2)	609 (81.0)	44 (54.3)	26 (61.9)	14 (45.2)	1 (33.3)	1 (50.0)	0 (0)	1 (100.0)	1331 (58.9)
Switch	128 (9.5)	33 (4.4)	14 (17.3)	5 (11.9)	7 (22.6)	1 (33.3)	1 (50.0)	0 (0)	0 (0)	189 (8.4)
End of enrollment	582 (43.3)	110 (14.6)	23 (28.4)	11 (26.2)	10 (32.3)	1 (33.3)	0 (0)	1 (100.0)	0 (0)	738 (32.7)
Liver directed therapy timing
During first-line	171 (12.7)	87 (11.6)	9 (11.1)	10 (23.8)	4 (12.9)	1 (33.3)	0 (0.0)	0 (0.0)	0 (0.0)	282 (12.5)
After first-line	36 (2.7)	39 (5.2)	7 (8.6)	0 (0.0)	2 (6.5)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	84 (3.7)
+/- 30 d after stopping first line therapy¹	635	609	44	26	14	1	1	0	1	1331
+/- 30 d after stopping first line therapy¹	29 (4.6)	42 (6.9)	2 (4.5)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	73 (5.5)

¹Among patients who stopped.

Table 3 Second-line treatment, stratified by first-line treatment n (%)

	First-line treatment							Patients withsecond-line treatment
	SSA	CC	TT	SSA + CC	SSA + TT	TT + CC	IF	Patients withsecond-line treatment
n	128	33	14	5	7	1	1	189
	67.7%	17.5%	7.4%	2.6%	3.7%	0.5%	0.5%	100.0%
Second-line treatment
SSA + TT	51 (39.8)	4 (12.1)	4 (28.6)	3 (60.0)		0 (0)	1 (100.0)	63 (33.3)
SSA + CC	33 (25.8)	6 (18.2)	0 (0)		5 (71.4)	0 (0)	0 (0)	44 (23.3)
CC	24 (18.8)		4 (28.6)	0 (0)	1 (14.3)	0 (0)	0 (0)	29 (15.3)
SSA		16 (48.5)	5 (35.7)	0 (0)	0 (0)	1 (100.0)	0 (0)	22 (11.6)
TT	12 (9.4)	7 (21.2)		2 (40.0)	0 (0)	0 (0)	0 (0)	21 (11.1)
SSA + IF	3 (2.3)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	3 (1.6)
IF	2 (1.6)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	2 (1.1)
TT + CC	1 (0.8)	0 (0)	1 (7.1)	0 (0)	0 (0)		0 (0)	2 (1.1)
SSA + TT + CC	1 (0.8)	0 (0)	0 (0)	0 (0)	1 (14.3)	0 (0)	0 (0)	2 (1.1)
SSA + CC + IF	1 (0.8)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	1 (0.5)

SSA: Somatostatin analogues; CC: Cytotoxic chemotherapy; TT: Targeted therapy; IF: Interferon.

Citation: Benson III AB, Broder MS, Cai B, Chang E, Neary MP, Papoyan E. Real-world treatment patterns of gastrointestinal neuroendocrine tumors: A claims database analysis. World J Gastroenterol 2017; 23(33): 6128-6136
URL: https://www.wjgnet.com/1007-9327/full/v23/i33/6128.htm
DOI: https://dx.doi.org/10.3748/wjg.v23.i33.6128