Earticle

OBJECTIVES Anti-cancer drug formulary needs to be periodically updated based on current clinical trial data. This study is to review current drug formulary for pancreatic neuroendocrine tumors (PNET) and then propose the updated reimbursement criteria. METHODS Based on the current anti-cancer drug formulary, the drugs on the list and newly approved drugs for the treatment of PNET were reviewed in the context of the evidence-based medicine practice. The oncology textbooks, narrative review articles and clinical practice guidelines were reviewed. PubMed search for the primary literature and systematic review was performed with MeSH terms (pancreatic neuroendocrine tumors, islet cell carcinoma, and gastroenteropancreatic neuroendocrine tumor). The medical articles were critically appraised with the literature evidence strength levels and the final new criteria were proposed. RESULTS Only one anti-cancer drug, sunitinib, had been recently approved for the PNET. Three randomized controlled trial literatures (evidence level category 2) were viewed to be selected to improve formulary. The anti-cancer drugs which usage was supported by the category 2 articles were interferon-alpha, sunitinib and everolimus. The latter two drugs that were not on the list yet should be included and their criteria should be specified by the patient characteristics in the clinical literature. CONCLUSIONS Sunitinib and everolimus should be listed on the anti-cancer drug formulary with a reimbursement criteria of “reatment of unresectable or metastatic, well-differentiated pancreatic neuroendocrine tumors with disease progression in adults”as described in the approved indication and published clinical trial data.