MethodsPhase II prospective study in patients with advanced neuroendocrine tumour.
Participants and Country78 patients, USA. 30/78 had known primary site and 48/78 had poorly differentiated neuroendocrine carcinoma of unknown primary tumour. 86% had good performance status (0 or 1), median age was 58 years.
Interventions88% of patients had at least two courses of treatment with paclitaxel, carboplatin and etoposide. Paclitaxel 200 mg/m^2 administered by 1 hr IV infusion on day 1; carboplatin at an area under the concentration-time curve of 6.0 IV on day 1; and etoposide 50 mg alternating with 100 mg orally on days 1 to 10. Treatment courses were repeated at 21 day intervals.
OutcomesTreatment response
In patients with CUP: complete response rate 6/48 (12.5%), partial response rate 20/48 (42%), overall response rate 26/48 (54%).
In patients with known primary: complete response rate 6/30 (20%), partial response rate 9/30 (30%), overall response rate 15/30 (50%).
Overall survival
In patients with CUP: median overall survival was 14.1 months (95% CI 9.5 to 18.5)
In patients with known primary: median overall survival was 15.6 months (95% CI 7.1 to 24.5)
Treatment toxicity (grade 3 or 4)
In the entire group: neutropenia in 82% of patients, thrombocytopenia in 31%, nausea and vomiting in 10%,
Treatment related death
In the entire group: 3/78 (4%) associated with neutropenic sepsis.
NotesAuthors argue that their previous results with platinum/etoposide were comparable to this regimen, and less toxic. They argue that patients with advanced PDNE should be treated with small cell lung cancer chemotherapy: preferably a platinum/etoposide regimen of brief duration.

From: Guideline chapter 5, Systemic Therapy

Cover of Diagnosis and Management of Metastatic Malignant Disease of Unknown Primary Origin
Diagnosis and Management of Metastatic Malignant Disease of Unknown Primary Origin.
NICE Clinical Guidelines, No. 104.
National Collaborating Centre for Cancer (UK).
Copyright © 2010, National Collaborating Centre for Cancer.

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