Background: Streptozocin (STZ) based chemotherapy is recommended for patients with metastatic pancreatic\nneuroendocrine tumors (pNET). Temozolomide as mono- or combination therapy has been suggested to be a\npromising alternative. However, the treatment is costly and not approved for the treatment of pNETs. Dacarbazine\n(DTIC) shares the active metabolite with temozolomide and is broadly available at a low cost. The aim of this study was\na retrospective evaluation of the efficacy and tolerability of a lower dose DTIC-regimen in patients with progressive\nadvanced NETs.\nMethods: We retrospectively analyzed 75 patients with NETs predominantly of pancreatic origin treated at our center\nbetween 1998 and 2013. 650 mg/m2 of DTIC were administered intravenously over 60 min every 4 weeks.\nMorphological response was assessed according to RECIST1.1 criteria. The median progression free survival (PFS) was\ncalculated using Kaplan-Meier and Cox regression methods, respectively. Univariate analyses of possible prognostic\nmarkers were performed.\nResults: The objective response rate (ORR) was 27 % for the entire cohort and 32 % in 50 pNET patients, respectively.\nStable disease (SD) was documented in 29 patients (39 %). Median PFS (mPFS) in patients receiving DTIC was 7 months\n(3.9ââ?¬â??10; 95 % confidence interval). Radiological and biochemical response were the only significant prognostic markers\nfor longer PFS in univariate analysis. Treatment was well tolerated. Nausea was the most common side effect (31 %),\nonly one case (1.3 %) of grade 3 toxicity (vomiting) occurred.\nConclusion: Low dose DTIC chemotherapy is an effective and well-tolerated treatment option in patients with\nprogressive well differentiated neuroendocrine neoplasms, especially of pancreatic origin.
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