So for patients with advanced digestive neuroendocrine carcinoma, there are a number of different options for treatment. And these would be based on guidelines and based on evidence base as much as possible. So for the first line treatment, platinum etoposide would be recommended either cisplatin or carboplatin. And there have been studies which have shown that actually there’s probably no difference whether you use cisplatin or carboplatin in terms of survival or response or outcome data...
So for patients with advanced digestive neuroendocrine carcinoma, there are a number of different options for treatment. And these would be based on guidelines and based on evidence base as much as possible. So for the first line treatment, platinum etoposide would be recommended either cisplatin or carboplatin. And there have been studies which have shown that actually there’s probably no difference whether you use cisplatin or carboplatin in terms of survival or response or outcome data. But there may be a difference in toxicities. So then there was a randomized trial a number of years ago, which was published in 2022. And this was an Asian study where patients were randomized to receive either cisplatin with etoposide or cisplatin with irinotecan. And they showed that there was no difference in the outcomes in patients who received either regimen. So in terms of median PFS, the median overall survival was around a year, and the response rate was around 50%. So in real-world outcomes, though, the overall survival is probably less, probably more like seven months, which was reported recently from the Nordic study. And that was probably due to more patients who were elderly and patients with poor performance status who were included in that study. And they had over 400 patients included with a new diagnosis. So then in the second line option, the second line option, standard of care, the best evidence is from randomized trials. And there were two randomized trials reported in 2023. One was the BEVANEC study, which was run in France, and the other was the NET-02 study, which included patients from the UK. So in both of those studies, the response rate in the NetO2 study was around 10%, and the response rate with the FOLFIRI in the BEVANEC study was around 18%. In the BEVANEC study, patients were randomized to receive either FOLFIRI or Folfiri bevacizumab. The median PFS was around three months, so not very good. And the median overall survival was around six months in the NET-02 study. And in the Bevacizumab study for the FOLFIRI, the median overall survival was just over eight months. So the authors of that study concluded that FOLFIRI, irinotecan with 5-fluorouracil, could be considered as a standard of care in the second-line option for these patients. There’s no real standard beyond that in terms of third-line options. Sometimes patients will receive FOLFOX, and that’s based really on looking at other disease groups. And at the moment, there are no targeted therapies for this, no approved targeted therapies or targeted therapies which have been shown to improve overall survival in this disease group.
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