Objective: First-line chemotherapy in metastatic neuroendocrine carcinomas (NEC) is based on etoposide and platinum. However, there is no standard concerning second-line treatment. The objective of this study was to evaluate efficacy and tolerance of dacarbazine or temozolomide in metastatic digestive NEC as post first-line treatment.
Material and Methods: This study included patients with a metastatic NEC of digestive or unknown primary site. All patients received platinum-etoposide as first-line chemotherapy. Primary endpoint was progression-free survival (PFS). Secondary endpoints were: clinical/morphological responses, toxicity, and overall survival (OS).
Results: 27 patients were included: 17 received dacarbazine and 10 temozolomide as post-first line treatments. Median PFS was 3.0 (95%CI [2.2;3.7]) months. There was no significant difference between dacarbazine and temozolomide on PFS. Clinical and morphological responses were found in 46% and 33% of patients, respectively. Median OS was 7.2 (95%CI [2.2;12.2]) months. The toxicity profile was that expected with such treatments.
Conclusion: This study confirms a poor prognosis of metastatic NEC during post first-line treatment. LV5FU2-Dacarbazine or temozolomide-capecitabine chemotherapies allow a temporary clinical response for half of patients and/or a morphological response for a third of patients.