Kjell Oberg, MD, PhD, Professor in the Department of Medical Sciences at the University Hospital in Uppsala, Sweden, discussed the CLARINET paper at the Presidential Session during the European Cancer Congress in Amsterdam. Dr. Oberg noted the curious observation that median progression-free survival for the placebo arms was 18 months in CLARINET but only 6 months in PROMID. He questioned whether this might be due to the inclusion of a “special cohort” of patients in CLARINET.

“The very long 18-month median progression-free survival in the placebo arm of CLARINET needs to be discussed,” he suggested. “Only patients who were stable for 6 months were included [progressive disease was allowed in PROMID]. The majority of patients were therapy-naive with a rather short medical history. The cell proliferation rate was low (78% grade 1, Ki67 < 2%), and the hepatic tumor load was
< 25% in 67% of patients. The patient material is obviously different from PROMID.”

Nevertheless, the benefit is clear, he said, concluding that previous restrictions on the use of somatostatin analogs to functioning tumors only is no longer justified. As a result of CLARINET, guidelines on this issue may change. ■

Disclosure: Dr. Oberg reported no potential conflicts of interest.