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Efficacy of FOLFOX with or without Bevacizumab in Patients with Aggressive Pancreatic NETs

2020 Year in Review - Neuroendocrine Tumors - Neuroendocrine Tumors

Results of a retrospective study indicate that the 5-fluorouracil + leucovorin + oxaliplatin (FOLFOX) ± bevacizumab regimen is active in patients with aggressive and heavily pretreated pancreatic neuroendocrine tumors (NETs) who have progressed on prior capecitabine + temozolomide chemotherapy.

A retrospective, single-institution study evaluated the efficacy of FOLFOX with or without bevacizumab in patients with aggressive pancreatic NETs who had progressed after capecitabine + temozolomide or other treatments; the results of this study were reported at the 2020 North American Neuroendocrine Tumor Society Annual Symposium.

This retrospective study included all patients with well-differentiated, metastatic pancreatic NETs treated at the Moffitt Cancer Center between January 2008 and June 2019, who had received salvage FOLFOX with or without bevacizumab and had progressed on prior capecitabine + temozolomide. The primary end point was objective response rate (ORR).

A total of 31 eligible patients were included in the analysis; of these, 25 patients received FOLFOX and 6 patients received FOLFOX + bevacizumab. The majority of patients were male (74%), had grade 2 tumors (52%), and had received a median of 3 to 4 prior lines of systemic therapy (range, 1-8).

The ORR was 45.2%; 14 patients achieved a partial response as best response and 15 (48.4%) patients achieved stable disease, for a disease control rate of 93.5%. The median progression-free survival (PFS) was 6 months (95% confidence interval [CI], 5.0-7.0); median overall survival (OS) was 16 months from the initiation of study treatment (95% CI, 11.3-20.7) and 67 months from the date of diagnosis (95% CI, 49.8-84.2). The addition of bevacizumab was not associated with benefit in terms of PFS (6 months vs 6 months) or OS (14 months vs 17 months). The median duration of treatment was 3 months, and median duration of response was 2 months. The toxicity profile was consistent with that previously described with the FOLFOX ± bevacizumab regimen.

The findings of this retrospective analysis indicate that the FOLFOX ± bevacizumab regimen is active in patients with aggressive and heavily pretreated pancreatic NETs who have progressed on prior capecitabine + temozolomide chemotherapy, warranting further investigation of this regimen in this population.

Source: Al-Toubah T, et al. North American Neuroendocrine Tumor Society 2020 Annual Symposium; October 1-3, 2020. Abstract C13.

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Last modified: July 22, 2021