1. The Efficacy of a Lower Dose of Everolimus in Patients with Advanced Neuroendocrine Tumors.
- Author
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Taboada, Rodrigo G., Brito, Angelo B., Silva, Ana Luiza, Weschenfelder, Rui F., and Riechelmann, Rachel P.
- Abstract
Simple Summary: Everolimus works against certain types of advanced neuroendocrine tumors. However, the approved dose of 10 mg orally per day can be toxic, with nearly 25% of patients experiencing serious side effects. Preliminary studies have shown that lower doses of everolimus may also be effective, and clinical trials often allow for dose reductions. However, there have not been comparisons between the effectiveness of lower and higher doses of everolimus. Our retrospective study aimed to compare how long neuroendocrine tumors were controlled with lower doses versus higher doses of everolimus. We found no significant differences in how long patients were able to stay on treatment with either dose. This result supports the conduction of a randomized clinical trial. Background: Everolimus at 10 mg daily is approved to treat patients with advanced grade 1/2 neuroendocrine tumors (NETs), although it may lead to significant toxicity. Grade 3 or higher drug-related adverse events and drug discontinuation occur in approximately one-fourth of cases. However, phase I trials have demonstrated that doses from 5 mg daily efficiently inhibit NET cell signaling. Objectives and Methods: This multicenter retrospective study compared the time to treatment failure (TTF) in patients with NETs who received a mean daily dose of 7–10 mg (higher dose [HD]) or ≤6 mg (lower dose [LD]) of everolimus. Results: Ninety-two patients were included: 74 (80%) in the HD group and 18 (20%) in the LD group. At a median follow-up of 4.2 years, the median time to treatment failure (TTF) was 9.2 months for the HD and 7.2 months for the LD groups (p = 0.85). The TTF did not significantly differ between the LD and the HD groups (HR: 1.24; 95% CI: 0.68–2.25; p = 0.47), even after adjusting for age at treatment initiation, the NET grade, and the treatment line. Conclusion: Everolimus doses from 5 to 6 mg/day seem to be equally as effective as higher doses, but lower doses are potentially associated with less toxicity and lower costs. These findings support validation through a randomized clinical trial. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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