Durable disease control with sunitinib and everolimus in well-differentiated neuroendocrine tumors of the pancreas with a high ki67 index.

e15161 Background: Everolimus and sunitinib have shown clinically meaningful improvements in progression free survival in well differentiated NET of the pancreas. Treatment with these agents is usually suggested in patients with Rindi grade 1 & 2 tumours, with a ki67 index up to 20%. Some patients with well differentiated tumours have a higher ki67 index. Methods: Since 2008, 11 patients with advanced well differentiated NET of the pancreas with a ki67 index of 15% or more (median 23 (IQR: 16–38%)) and uptake of lesions on octreoscan and/or gallium68 dotatoc were treated with sunitinib and/or everolimus. Some also had positive lesions on FDG-PET scan. Results: Four patients showed progression at the time of first evaluation. Two of them had a Rindi grade 2 tumour and two had bone lesions. All were subsequently treated with cisplatinum-etoposide and 3 patients had a response. The median ki67 index in the 7 other patients was 23 (IQR: 18–36%). Overall in these patients, the disease was controlled for a median of 18 (14-23) months on sunitinib and/or everolimus. Three patients have only been treated with sunitinib thus far. Two of them have been referred for PRRT and are alive and well 6 and 16 months after the start of PRRT. Four patients were treated with both sunitinib and everolimus. One of them is alive without treatment after failure of both oral drugs and 21 months after start of PRRT. The 3 remaining patients are still either on everolimus or sunitinib. Conclusions: Sunitinib and/or everolimus may induce a durable disease control in patients with a well differentiated NET of the pancreas with a ki 67 index above 15% and positive lesions on functional imaging with gallium68 dotatoc and/or octreoscan. Uptake on FDG-PET should not refrain from trying these treatments. Patients with bone lesions are less likely to respond.