BPI21-009: Survival Benefit of Adjuvant Chemotherapy in Pulmonary Carcinoid: A Systematic Review

Authors: Philip Sobash MD1 and Nagla Abdel Karim MD2
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  • 1 White River Health System, Batesville, AR
  • | 2 Augusta University, Georgia Cancer Center, Augusta, GA

Background: The use of adjuvant chemotherapy following the surgical resection of pulmonary typical or atypical carcinoids has been highly debated. Guidelines currently indicate potential chemotherapy treatment for Stage IIIA disease in typical or atypical disease and metastatic disease. Aim of the study is to explore the benefit of adjuvant therapy for thoracic carcinoid tumors. Methods: A literature review was conducted through PubMed in accordance with PRISMA guidelines to identify studies evaluating the use and survival analysis of adjuvant chemotherapy in typical and/or atypical over the past 10 years. Due to the heterogeneity of studies, outcomes of interest were survival OS, RFS, Median Survival and survival at 1 and 5 years. Results: A total of 80 studies were identified through PubMed search of “chemotherapy” AND “pulmonary” AND “carcinoid.” Case reports and studies not reported in English were excluded. Of those 80 retrieved, 12 were identified for potential review based on abstract review. Of those 12, only 4 clearly reported any survival statistics on typical and/or atypical carcinoids treated with a chemotherapy regimen. Among all studies, not all reported what types of chemotherapy were used in the study. Many studies reported conclusions, but samples were either too small for statistical analysis, or they did not provide statistical values based on survival and were therefor not included. The outcomes varied by study including median survival, 1- and 5-year survival, PFS and OS. Of the 4 reported none showed a statistically significant advantage with either chemotherapy vs observation or chemotherapy in nodal vs non-nodal disease. Conclusions: Although survival was reported differently across studies, no study found any benefit for adjuvant therapy versus no treatment, regardless of nodal status. One study showed a negative outcome with the administration of adjuvant therapy. Although the NCCN guidelines state the use of chemotherapy in the intermediate grade (atypical) carcinoid (Category IIB) stage the literature demonstrates no clear survival advantage conferred when doing so. There is need for prospective studies to further evaluate the utilization of adjuvant therapy in atypical carcinoid.

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Corresponding Author: Philip Sobash, MD
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