Real-world data from a retrospective analysis of octreotide long-acting release (LAR) dosing patterns on treatment persistence in patients with symptomatic metastatic neuroendocrine tumors (NETs) indicate that physician experience and treatment at tertiary centers has a significant impact on dose selection and treatment persistence.
At the 2020 North American Neuroendocrine Tumor Society Annual Symposium, real-world data from a retrospective analysis of the impact of octreotide LAR dosing patterns on treatment persistence in patients with symptomatic metastatic NETs in Canada were reported.
The retrospective analysis included patients enrolled in the Sandostatin Patient Support Program in Canada between March 2008 and December 2018. A total of 2047 patients with NETs were enrolled in the analysis; the median age was 63.53 years. Overall, 2% of patients initiated octreotide LAR at 10 mg, 32% at 20 mg, 64% at 30 mg, and 2% at >30 mg. The majority of patients (64%) received octreotide LAR at a 28-day dosing frequency. Physicians who treat a higher number of NET patients (>20 patients) were found to be more likely to initiate patients on the 30-mg dose. A greater number of patients treated at tertiary institutions (70%) were initiated at the 30-mg dose, compared with 56% at large urban centers and 41% at suburban centers.
A higher percentage of patients who initiated at the 30-mg dose remained on the same dose compared with those who initiated at 20 mg (79% vs 46%); 38% of patients initiated at 20 mg increased their dose to 30 mg. Overall persistence at 1 year was 67.7%, which decreased to 44.4% at 3 years; the median persistence was 857 days. Of the 2047 eligible patients who received octreotide LAR, 752 remained on treatment and 1290 discontinued; the most common reasons for discontinuation included death (42%), transition to palliative care (9%), and switch to alternative treatment (8%). Treatment persistence showed a trend to be higher in patients initiated at 30 mg compared with those who initiated at 20 mg (P = .0449). Treatment persistence also significantly correlated with clinician experience (1007 days for clinicians treating 5-25 patients vs 572 days for those treating 1-2 patients; P <.0001) and was numerically higher in patients with gastrointestinal NETs versus pancreatic NETs (931 days vs 731 days).
These findings indicate that physician experience and treatment at tertiary centers has a significant impact on treatment dose selection and persistence, suggesting that centralizing care to higher-volume centers may positively impact persistence.
Source: Singh S, et al. North American Neuroendocrine Tumor Society 2020 Annual Symposium; October 1-3, 2020. Abstract O10.
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