Research Article Neuroendocrinology 2020;110:653–661 Elderly Patients with Metastatic Neuroendocrine Tumors Are Undertreated and Have Shorter Survival: The LyREMeNET Study Annie Lemelin a Delphine Maucort-Boulch b, g Elisabeth Castel-Kremer c Julien Forestier a Valérie Hervieu d, g Marianne Lorcet a Florent Boutitie b Aurélie Theillaumas a Philip Robinson e Antoine Duclos f, g Catherine Lombard-Bohas a Thomas Walter a, g a Service de Gastroentérologie et d’Oncologie Médicale, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France; b Service de Biostatistique, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Hospices Civils de Lyon, Université Lyon 1, Lyon, France; c Service de Médecine Gériatrique, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France; d Service Central d’Anatomie et Cytologie Pathologiques, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France; e DRCI, Hospices Civils de Lyon, Lyon, France; f Service des Données de Santé, Hospices Civils de Lyon, Health Services and Performance Research lab (HESPER EA 7425), Lyon, France; g Lyon 1 Claude Bernard University, Lyon, France Received: April 27, 2019 Accepted after revision: October 4, 2019 Published online: October 7, 2019 Thomas Walter Service de Gastroentérologie et d’Oncologie Médicale, Hospices Civils de Lyon Hôpital Edouard Herriot, Pavillon E, UJOMM FR–69437 Lyon Cedex 03 (France) E-Mail thomas.walter @chu-lyon.fr © 2019 S. Karger AG, Basel karger@karger.com www.karger.com/nen DOI: 10.1159/000503901 Keywords Neuroendocrine tumor · Metastatic neuroendocrine tumor · Elderly · Prognosis · Treatment Abstract Introduction: The incidence of neuroendocrine tumors (NETs) is rising, especially in elderly patients. The elderly can- cer population presents considerable challenges, yet little is known about the characteristics, treatment patterns, and outcomes of metastatic NET (mNET) patients. Methods: The Lyon Real-life Evidence in Metastatic NeuroEndocrine Tu- mors study (LyREMeNET, NCT03863106) included consecu- tive mNET patients, diagnosed between January 1990 and December 2017. The exclusion criteria were nonmetastatic NET, poorly differentiated neuroendocrine carcinoma, and mixed neuroendocrine-nonneuroendocrine neoplasms. We aimed to compare patients ≥70 years old to patients <70 years old. Results: A total of 866 patients were included, 198 (23%) were ≥70 years old. There was no significant differ- ence in characteristics except that elderly patients had syn- chronous metastasis more frequently. Elderly patients re- ceived significantly fewer treatments (median of 2.0 vs. 3.0 lines, respectively, p < 0.0001), were significantly less fre- quently treated by chemotherapy (32 vs. 54%), targeted therapy (16 vs. 30%), peptide receptor radionuclide therapy (5 vs. 16%), and they underwent significantly less frequently locoregional intervention. Median overall survival was sig- nificantly shorter in elderly patients (5.2 vs. 9.6 years). The most frequent cause of death was related to disease progres- sion (71%). Multivariate analysis found that, after adjustment for tumor location, tumor grade, and number of metastatic sites, age remained significantly associated with overall sur- vival (HR 1.66, 95% CI 1.26–2.18), indicating a poorer survival in patients ≥70 years old in comparison with younger pa- tients (p = 0.0003). Conclusion: Patients ≥70 years old have a worse survival, die frequently from their disease, and are undertreated compared to younger patients. © 2019 S. Karger AG, Basel Downloaded from http://karger.com/nen/article-pdf/110/7-8/653/3908060/000503901.pdf by guest on 05 September 2023