In the present study, we have updated our results with
chemotherapy,
alpha-interferon,
octreotide and combinations of treatment modalities in patients with malignant endocrine pancreatic
tumor (EPT). In our patient material of 134 EPT, 92 subjects had malignant
tumors as evidenced by the presence of
metastases or growth into adjacent organs. Seventy-eight patients had liver
metastases.
Streptozotocin plus
5-fluorouracil produced objective responses in 17/31 (54%) patients with a median duration of response of 23 months. The use of 5-HT3-antagonists as
antiemetics has dramatically improved the quality of life during treatment by reducing the frequency of
nausea to only 12.5%. The objective response rate to
alpha-interferon (alpha-IFN) treatment, given as first-line treatment in 29 patients and after
chemotherapy in 28 patients, was 51% (29/57) with a median duration of response of 20 months.
Octreotide, which is still used as third-line treatment in most patients, produced significant biochemical responses in 6/19 (31%) patients with a median duration of 16 months. Combinations of alpha-IFN plus
chemotherapy and a alpha-IFN plus
octreotide in a small number of patients might indicate additive or synergistic effects. The median survival from start of treatment in the 92 malignant cases was 56.5 months, and for those with liver
metastases (n = 78) at start of treatment 50 months. In conclusion, there are at least three effective
therapies for malignant EPT and by combining them simultaneously or consecutively, a median survival of more than four years can be obtained.