Gemcitabine as Salvage Treatment in Patients with Poorly Differentiated Pancreatic Neuroendocrine Tumors: A Case Series

  • Muhammad Wasif Saif Section of GI Cancers and Experimental Therapeutics, Tufts University School of Medicine. Boston, MA, USA
  • Kristin Kaley Yale School of Medicine. New Haven, CT, USA
  • Teresa Rodriguez Columbia University Medical Center. New York, NY, USA
  • Marie Carmel Garcon Columbia University Medical Center. New York, NY, USA
Keywords: Carcinoid Tumor, Drug Therapy, gemcitabine, Neuroendocrine Tumors, Pancreatic Neoplasms


Context Poorly differentiated neuroendocrine carcinoma of the pancreas is a rare and aggressive tumor. The combination of etoposide and cisplatin is considered as the first-line treatment, but no recommendations exist for further treatment after progression. Case series We report here case series of three patients who received gemcitabine as salvage chemotherapy in patients with poorly differentiated neuroendocrine carcinoma of the pancreas. All the three patients achieved clinical benefit with manageable toxicities. The survival was 5.5, 8, and 9 months respectively after the beginning of gemcitabine in these three patients. Conclusions This case series of patients with poorly differentiated neuroendocrine carcinoma of the pancreas who received gemcitabine as salvage chemotherapy suggests that gemcitabine could be an effective salvage treatment. Future studies to investigate gemcitabine in this setting are warranted.

Image: Gemcitabine.


Download data is not yet available.


Dimou AT, Syrigos KN and Saif MW: Neuroendocrine tumors of the pancreas: what's new. Highlights from the "2010 ASCO Gastrointestinal Cancers Symposium". Orlando, FL, USA. January 22-24, 2010.JOP. 11(2):135-8, 2010.

Yao JC, Hassan M, Phan A Phan A, Dagohoy C, Leary C, Mares JE, Abdalla EK, Fleming JB, Vauthey JN, Rashid A and Evans DB: One hundred years after "carcinoid": epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol. 26:3063-72, 2008.

Eriksson B, Oberg K and Skogseid B: Neuroendocrine pancreatic tumors. Clinical findings in a prospective study of 84 patients. Acta Oncol. 28:373–377. 1989

Nilsson O, Van Cutsem E and Delle Fave G: Poorly differentiated carcinomas of the foregut (gastric, duodenal and pancreatic). Neuroendocrinology. ;84:212-215. 2006.

Moertel CG, Kvols LK, O’Connell MJ and Rubin J: Treatment of neuroendocrine carcinomas with combined etoposide and cisplatin. Evidence of major therapeutic activity in the anaplastic variants of these neoplasms. Cancer. 68:227–232. 1991.

Fjällskog ML, Granberg DP, Welin SL, Eriksson C, Oberg KE, Janson ET and Eriksson BK: Treatment with cisplatin and etoposide in patients with neuroendocrine tumors. Cancer. 92:1101–1107. 2001.

Mitry E, Baudin E, Ducreux M, Sabourin JC, Rufié P, Aparicio T, Aparicio T, Lasser P, Elias D and Duvillard P: Treatment of poorly differentiated neuroendocrine tumours with etoposide and cisplatin. Br J Cancer. 81:1351–1355.1999. (last assessed May 24, 2013)

Saif MW, Kaley K, Penney R, Hotchkiss S, Syrigos KN and Strimpakos AS: The efficacy of gemcitabine as salvage treatment in patients with refractory advanced colorectal cancer (CRC): a single institution experience. Anticancer Res. 31(9):2971-4.2011.

Nakazuru S, Yoshio T, Suemura S, Itoh M, Araki M, Yoshioka C, Ohta M, Sueyoshi Y, Ohta T, Hasegawa H, Morita K, Toyama T, Kuzushita N, Kodama Y, Mano M and Mita E: Poorly differentiated endocrine carcinoma of the pancreas responded to gemcitabine: Case report. World J Gastroenterol. 16(30):3853-6. 2010.

Brown DB, Gonsalves CF, Yeo CJ, Witkiewicz AK and Carr BI: One year survival with poorly differentiated metastatic pancreatic carcinoma following chemoembolization with gemcitabine and cisplatin. Oncol Rep. 24(3):767-9. 2010.

Yoshida Y, Sugawara N, Minami T, Iwata N, Ikeda K, Endoh T and Sasano H: A case of pancreatic neuroendocrine tumor with excessively-advanced liver metastasis treated with S-1/GEM combination chemotherapy plus the long-acting somatostatin analogue octreotide. Nihon Shokakibyo Gakkai Zasshi. 110(4):660-8. 2013.

Yamamoto M, Miyagawa K, Hiura M, Taguchi M, Kihara Y, Abe S, Shimajiri S and Harada M: Poorly differentiated neuroendocrine carcinoma of the pancreas responsive to combination therapy with gemcitabine and S-1. Intern Med. 51(7):727-32. 2012.

Cormier Y, Eisenhauer E, Muldal A, Gregg R, Ayoub J, Goss G, Stewart D, Tarasoff P and Wong D: Gemcitabine is an active new agent in previously untreated extensive small cell lung cancer (SCLC). A study of the National Cancer Institute of Canada Clinical Trials Group. Ann Oncol. 5:283–285. 1994.

Masters GA, Declerck L, Blanke C, Sandler A, DeVore R, Miller K and Johnson D: Phase II trial of gemcitabine in refractory or relapsed small-cell lung cancer: Eastern Cooperative Oncology Group Trial 1597. J Clin Oncol. 21:1550–1555. 2003.

Ansell SM, Pitot HC, Burch PA, Kvols LK, Mahoney MR and Rubin J: A Phase II study of high-dose paclitaxel in patients with advanced neuroendocrine tumors. Cancer. 91:1543–1548. 2001.

Ansell SM, Mahoney MR, Green EM and Rubin J: Topotecan in patients with advanced neuroendocrine tumors: a phase II study with significant hematologic toxicity. Am J Clin Oncol. 27:232–235. 2004.

Noda K, Nishiwaki Y, Kawahara M, Negoro S, Sugiura T, Yokoyama A, Fukuoka M, Mori K, Watanabe K and Tamura T: Irinotecan plus cisplatin compared with etoposide plus cisplatin for extensive small-cell lung cancer. N Engl J Med. 346:85–91. 2002.

Burris HA 3rd, Moore MJ, Andersen J, Green MR, Rothenberg ML, Modiano MR, Cripps MC, Portenoy RK, Storniolo AM and Tarassoff P: Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol. 15:2403–2413. 1997.

Kulke MH, Kim H, Clark JW, Enzinger PC, Lynch TJ, Morgan JA, Vincitore M, Michelini A and Fuchs CS: A Phase II trial of gemcitabine for metastatic neuroendocrine tumors. Cancer. 101:934–939. 2004.

Hentic O, Hammel P, Couvelard A, Rebours V, Zappa M, Palazzo M, Maire F, Goujon G, Gillet A, Lévy P, Ruszniewski P. FOLFIRI regimen: an effective second-line chemotherapy after failure of etoposide-platinum combination in patients with neuroendocrine carcinomas grade 3. Endocr Relat Cancer. 2012 Nov 6;19(6):751-7.

Welin S, Sorbye H, Sebjornsen S, Knappskog S, Busch C, Oberg K. Clinical effect of temozolomide-based chemotherapy in poorly differentiated endocrine carcinoma after progression on first-line chemotherapy. Cancer. 2011 Oct 15;117(20):4617-22.

How to Cite
SaifM., KaleyK., RodriguezT., & GarconM. (2014). Gemcitabine as Salvage Treatment in Patients with Poorly Differentiated Pancreatic Neuroendocrine Tumors: A Case Series. JOP. Journal of the Pancreas, 15(1), 38-41.

Most read articles by the same author(s)