Failure to confirm major objective antitumor activity for streptozocin anddoxorubicin in the treatment of patients with advanced islet cell carcinoma

BACKGROUND, The combination regimen of streptozocin plus doxorubicin is the current standard chemotherapeutic treatment of symptomatic or progressing met; astatic islet cell carcinoma. This regimen previously has been reporte d to have a major objective response rate of 69% in a randomized cooperativ e group trial. However, the authors believed that this favorable response r are was not consistent with their institutional experience at Memorial Sloa n-Kettering Cancer Center (MSKCC). METHODS. The authors retrospectively reviewed the records of all islet cell carcinoma patients under care at MSKCC who were treated with streptozocin plus doxorubicin since the publication of the study mentioned earlier. Sixt een such patients treated between February 1992 and February 1998 were iden tified. Their clinical characteristics, sites of measurable disease, respon se to treatment, time to treatment failure, and survival status were review ed. RESULTS. All patients were treated with the starting doses as outlined by t he published cooperative group report. AU had bidimensionally measurable di sease on computed tomography (CT) scans. Only 1 of 16 patients (6%; 95% con fidence interval, 0-30%) achieved a major objective response by standard CT response criteria, with response ongoing during treatment at 18 months. Ni ne patients (56%) had stable disease while receiving treatment (range of tr eatment, 2-17+ months). Six patients (38%) had progression of disease as th eir best response while receiving treatment. The median overall survival of this patient group had not yet been reached at last follow-up, with > 60% of patients alive with follow-up ranging from 10-67+ months. CONCLUSIONS. A retrospective analysis of the authors' g-year experience wit h the combination of streptozocin plus doxorubicin in patients with islet c ell carcinoma failed to confirm the high objective response rate previously reported for this regimen. There remains an urgent need for improved chemo therapeutic alternatives for patients with this disease. (C) 1999 American Cancer Society.