Document Detail


Systemic treatment in unresectable metastatic well-differentiated carcinoid tumors: consensus results from a modified delphi process.
MedLine Citation:
PMID:  23211372     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study aimed to develop expert consensus for the use of systemic treatments for unresectable metastatic well-differentiated (grade 1-2) carcinoid tumors using the RAND/UCLA modified Delphi process.
METHODS: After a comprehensive literature review, 404 patient scenarios addressing the use of systemic treatments for carcinoid tumors were constructed. A multidisciplinary panel of 10 physicians assessed the scenarios as appropriate, inappropriate, or uncertain (on a 1-9 scale) or as an area of disagreement before and after an extended discussion of the evidence.
RESULTS: Experts were medical and surgical oncologists, interventional radiologists, and gastroenterologists. Among rated scenarios, disagreement decreased from 14% before the meeting to 4% after. Consensus statements about midgut carcinoids included the following: (1) Somatostatin analogs are appropriate as first-line therapy for all patients; (2) In patients with uncontrolled secretory symptoms, it is appropriate to increase the dose/frequency of octreotide long-acting repeatable up to 60 mg every 4 weeks or up to 40 mg every 3 weeks as second-line therapy for refractory carcinoid syndrome. Other options may also be appropriate. Consensus was similar for non-midgut carcinoids.
CONCLUSIONS: The Delphi process provided a structured methodological approach to assist clinician experts in reaching consensus on the appropriateness of specific medical therapies for the treatment of advanced carcinoid tumors.
Authors:
Jonathan R Strosberg; George A Fisher; Al B Benson; Jennifer L Malin; ; Dasha Cherepanov; Michael S Broder; Lowell B Anthony; Bulent Arslan; George A Fisher; John F Gibbs; Edward Greeno; Renuka V Iyer; Michelle K Kim; William Maples; Philip A Philip; Jonathan Strosberg; Edward M Wolin
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pancreas     Volume:  42     ISSN:  1536-4828     ISO Abbreviation:  Pancreas     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-03-15     Completed Date:  2013-08-30     Revised Date:  2014-04-08    
Medline Journal Info:
Nlm Unique ID:  8608542     Medline TA:  Pancreas     Country:  United States    
Other Details:
Languages:  eng     Pagination:  397-404     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
Carcinoid Tumor / drug therapy*,  pathology
Consensus*
Delphi Technique*
Drug Administration Schedule
Expert Testimony
Gastrointestinal Neoplasms / drug therapy,  pathology
Humans
Neoplasm Metastasis
Octreotide / administration & dosage
Peptides, Cyclic / administration & dosage
Reproducibility of Results
Somatostatin / administration & dosage,  analogs & derivatives
Chemical
Reg. No./Substance:
0/Peptides, Cyclic; 118992-92-0/lanreotide; 51110-01-1/Somatostatin; RWM8CCW8GP/Octreotide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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