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Meta-analysis: Combo therapies best for neuroendocrine tumors

Kaderli RM et al. JAMA Oncol. 2019 Feb 14. doi: 10.1001/jamaoncol.2018.6720

Key clinical point: A wide range of safe and effective therapies exist for the treatment of patients with neuroendocrine tumors.

Major finding: In all, 22 distinct therapies were found for neuroendocrine tumors.

Study details: Systematic review and meta-analysis of 30 randomized clinical trials.

Disclosures: The study was supported by funding from the Insula Stiftung zur Förderung der viszeralchirurgischen Forschung. The authors reported no conflicts of interest.

Citation:

Kaderli RM et al. JAMA Oncol. 2019 Feb 14. doi: 10.1001/jamaoncol.2018.6720.

Commentary:

One question that remains from the study by Reto M. Kaderli, MD, and his colleagues is the comparative advantages and disadvantages of the various therapies used to treat patients with neuroendocrine tumors.

Recently, several novel therapies have been approved for the treatment of pancreatic and gastrointestinal neuroendocrine tumors, which include agents used for both tumor and symptom control. The majority of studies that evaluated these agents compared them with a comparator of unclear efficacy or placebo. As a result, it is challenging to compare and contrast these competing therapies with respect to efficacy and safety.

Other challenges also exist, such as the biological and clinical diversity seen with neuroendocrine tumors. The current body of literature contains studies that examined different tumor types, including pancreatic, midgut, or gastroenteropancreatic neuroendocrine tumors, which caused significant variation in outcomes. Similar difficulties were seen with the response criteria across these studies.

These results support the active recruitment of patients into randomized comparison studies, which compare these therapies directly. While these types of studies will require larger sample sizes versus placebo-controlled trials, they are necessary to better understand which agents are best in different subtypes of neuroendocrine tumors.

Jonathan R. Strosberg, MD, and Taymeyah Al-Toubah, MPH, are affiliated with the department of gastrointestinal oncology at H. Lee Moffitt Cancer Center and Research Institute in Tampa. Mauro Cives, MD, is affiliated with the department of biomedical sciences and human oncology at the University of Bari in Italy. Dr. Strosberg reported having financial affiliations with Ipsen, Lexicon, and Novartis. These comments are adapted from their accompanying editorial (JAMA Oncol. 2019 Feb 14. doi: 10.1001/jamaoncol.2018.6694 .