UKINETS2018 Poster Presentations (1) (28 abstracts)
Tumour growth rate (TGR) in neuroendocrine tumours (NETs): changes following systemic treatment and external validation of previous findings; the GREPONET-2 study
Angela Lamarca 1 , Maxime Ronot 2 , Salma Moalla 3 , Joakim Crona 4 , Marta Opalinska 5 , Carlos Lopez-Lopez 6 , Daniela Pezzutti 7 , Pavan Najran 8 , Luciana Carvhalo 9 , Regis Otaviano Franca Bezerra 10 , Philip Borg 8 , Naik Vietti-Violi 11 , Hector Vidal-Trueba 12 , Louis de Mestier 13 , Niklaus Scaefer 14 , Eric Baudin 15 , Anders Sundin 16 , Frederico Costa 9 , Marianne Pavel 17 & Clarisse Dromain 11
1Department of Medical Oncology; The Christie NHS Foundation Trust, Manchester, UK; 2Department of Radiology; Beaujon University Hospital, Clichy, France; 3Department of Radiology, Institute Gustave Roussy, Paris, France; 4Department of Medical Sciences; Uppsala University Hospital, Uppsala, Sweden; 5Nuclear Medicine Unit, Department of Endocrinology; University Hospital Krakow, Krakow, Poland; 6Department of Medical Oncology; Hospital Universitario Marques de Valdecilla, Santander, Spain; 7Department of Radiology; Israelita Albert Einstein Hospital, Sao Paulo, Brazil; 8Department of Radiology; The Christie NHS Foundation Trust, Manchester, UK; 9Department of Medical Oncology; Sirio-Libanes Hospital, Sao Paulo, Brazil; 10Department of Radiology; Sirio-Libanes Hospital, Sao Paulo, Brazil and São Paulo Cancer Institute Octavio Frias de Oliveira (ICESP), Sao Paulo, Brazil; 11Department of Radiology; CHUV University Hospital, Laussane, Switzerland; 12Department of Radiology; Hospital Universitario Marques de Valdecilla, Santander, Spain; 13Department of Gastroenterology; Beujon University Hospital, Clichy, France; 14Department of Medical Oncology; CHUV University Hospital, Laussane, Switzerland; 15Department of Nuclear Medicine, Institute Gustave Roussy, Paris, France; 16Department of Radiology; Institution of Surgical Sciences, Uppsala University Hospital, Uppsala, UK; 17Department of Endocrinology; Universitatsklinikum Erlangen, Erlangen, Germany.
Background: TGR represents the percentage change in tumour volume per month (%/m). Previous results from the GREPONET study (A. Lamarca et al, ENETS 2018) showed that TGR measured after 3 months (TGR3m) of starting systemic treatment (ST) or watch and wait (WW) was an early biomarker predicting progression-free survival (PFS) in NETs.
Methods: Pts from 7 centres with advanced grade (G) 1/2 NETs from the pancreas (P)/small bowel (SB) initiating ST/WW were eligible. Scans performed at pre-baseline, baseline and 3(+/−1) months of study entry were retrospectively reviewed for calculation of TGR at baseline (TGR0) and TGR3m. Study objectives included: Aim-1: explore treatment-induced changes in TGR (TGR3m-TGR0) (paired T-test) and Aim-2: validate TGR3m (<0.8%/m vs ≥0.8%/m) as an early biomarker in an independent cohort (Kaplan-Meier/Cox Regression).
Results: Out of 785 pts screened, 127 were eligible. Patient characteristics: 59.1% P, 40.9% SB; 62.9% G2; 72.4% ST-naïve. ST: somatostatin analogues 37.8%, chemotherapy 32.3%, targeted therapies 18.1%, PRRT 3.9%; WW 7.9%. Mean (SD) TGR0 and TGR3m were 5.4 (14.9) and −1.4 (11.8), respectively. Mean (SD) paired-difference between TGR3m-TGR0m was −6.8 (19.3) (P<0.001). Subgroup analysis by type of ST showed most marked TGR-changes (mean (SD); P) with targeted therapies (−11.3 (4.7); 0.0237) and chemotherapy (−7.9 (3.4); 0.0261). Median PFS for patients eligible for Aim-2 (n=97) was 16.2 m (95%CI 11.7–18.6); median follow-up 22.9 m. TGR3m cut-off of 0.8%/m stratified pts in two groups with different outcomes: the pts with TGR3m≥0.8 (31 pts; 31.9%) had a significantly shorter median PFS (12.2 m (95%CI 5.6–16.2)) vs. TGR3m<0.8 (66 pts; 68.1%; median PFS 18.6 m (95%CI 10.8–20.9)); Cox univariate P 0.011. Both TGR3m and tumour grade were significant in univariate Cox regression and included in multivariable Cox regression: TGR3m≥0.8 (vs.<0.8) (HR 2.55 [95%CI 1.64–3.97]; P<0.001), grade 2 (vs.1) (HR 2.02 (95%CI 1.25–3.27); P 0.004).
Conclusion: TGR varies significantly after treatment initiation, thus suggesting its role as biomarker for monitoring response to therapy. The role of high TGR3m as a factor associated with shorter PFS was validated in this independent cohort and maintained its robustness as an early radiological biomarker.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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