Endocrine Abstracts

Interferon alfa-2a was discontinued in June 2020. Here we present a case of an unfortunate patient for whom this change has dramatically impacted the course of her illness. A 64-year-old woman initially presented in 2007 with refractory hypertension and was found to have a phaeochromocytoma which was resected. Metastatic recurrence of her disease in the liver and vertebrae was confirmed by CT/MRI in 2014 following rising catecholamines on monitoring. Her MIBG scan in early 2015 revealed no uptake. Whilst on phenoxybenzine, somatostatin-analogues and cyclophosphamide, vincristine and dacarbazine over the next two years her disease continued to progress both on imaging and biochemical markers. Her quality of life had deteriorated to WHO performance status 3. She started on Interferon alfa-2a in June 2017 (repeat MIBG scan again showed no uptake). Her disease stabilised from this point and her biochemical markers normalised. Her performance status improved and she had a good quality of life for two years with stable disease on her scans up to June 2020. Interferon alfa-2a became unavailable from March 2020 due to the manufacturer discontinuing production and patients were started on Peginterferon as an alternative. From June 2020 our patient’s metanephrines began rising quickly and CT scans showed hepatic disease progression. This was followed with an admission (August 2020) with uncontrolled hypertension and falls from orthostatic hypotension. Despite significant input and medication management between oncology and endocrinology teams she was discharged with increased care and a reduced prognosis. This has remained an issue and her quality of life is greatly reduced. Quick review of the disease course of our patients (4 total) on Peginterferon revealed a 72-year-old with a metastatic small bowel NET previously stable on Interferon alfa-2a now progressing on a CT scan in August 2020 since switching. Other patients’ diseases remained stable or were not comparable to our case. This case illustrates the detrimental impact the discontinuation of drugs which may not be considered viable by the industry, but have a significant impact on survival and QOL. Discontinuation of this drug deprived a small proportion of patients with NETs a valuable and important treatment.