Real-world application of surufatinib in the treatment of neuroendocrine tumors: a multi-center retrospective study in China

Recently, the incidence of neuroendocrine tumors (NETs), characterized by neuroendocrine differentiation, has increased. Their heterogeneous origins and biological behaviors complicate diagnosis and treatment. Surufatinib, a novel oral tyrosine kinase inhibitor with dual anti-angiogenic and immunomodulatory properties, has shown promising efficacy against NETs in recent clinical trials. However, comparative data on the prognostic impact of surufatinib treatment remain limited. We investigated risk factors associated with mortality and tumor progression in patients with NETs, and aimed to provide insights into the administration of surufatinib to improve the clinical outcomes of these patients. In this multi-center, observational study, we retrospectively analyzed 373 patients diagnosed with NETs and followed up for 1 year. All patients received anti-tumor treatments during their hospitalization, including chemotherapy, radiotherapy, surgery, and immunosuppressants. Among them, 93 patients received surufatinib. Logistic regression was performed to identify potential risk factors, which were subsequently adjusted for confounding variables using a Cox proportional hazards regression model. Multivariable analysis revealed that surufatinib use was an independent risk factor for death (OR 0.36, P = 0.006) and disease progression (OR 0.44, P = 0.005). Survival analysis showed significantly higher overall (HR 0.44, 95% CI 0.26-0.76, P = 0.003) and progression-free survival (HR 0.56, 95% CI 0.37-0.84, P = 0.005) among patients treated with surufatinib than those in patients not receiving treatment. A higher proportion of patients in the surufatinib treatment cohort experienced proteinuria (9 [3.2%] vs. 10 [10.8%], P = 0.010) and increased blood bilirubin levels (25 [8.9%] vs. 16 [17.2%], P = 0.027), however, no significant differences were observed in the severity of adverse reactions. Surufatinib showed clinically meaningful efficacy in patients with NETs and exhibited a generally manageable safety profile.