ASO Author Reflection: Postoperative Chemotherapy for Nonmetastatic, Poorly Differentiated Gastroenteropancreatic Neuroendocrine Carcinomas

Excerpt

Poorly differentiated gastroenteropancreatic neuroendocrine carcinomas (GEP NEC) represent a heterogenous group of rare but aggressive tumors. Unfortunately, there are no high-level evidence data published to guide multimodal therapy. Treatment recommendations are based on retrospective data and recommendations for small cell lung cancer (SCLC), given the biological similarities. The current North American Neuroendocrine Tumor Society (NANETS) guidelines, published in 2010, recommended postoperative therapy with 4–6 cycles of cisplatin or carboplatin and etoposide, in combination with radiation for patients at high risk of local recurrence and low expected morbidity.1 The 2019 National Comprehensive Cancer Network (NCCN) guidelines also recommend resection and adjuvant chemotherapy with or without radiation therapy in resectable disease.2 The tumor Ki-67 index is an important factor that has clearly been identified to be associated with response rates and patient survival, allowing some degree of personalized treatment.3 In the current study, we sought to investigate the relationship between postoperative chemotherapy and patient survival after resection of nonmetastatic, poorly differentiated NEC of the stomach, small bowel, and pancreas with curative intent. We utilized the National Cancer Database (NCDB) to study a large population, and we applied the inverse probability of treatment weighting (IPTW) method to reduce the selection bias.4 …