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Imaging of Neuroendocrine Neoplasms: Monitoring Treatment Response—AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2022; 218:767-780. [DOI: 10.2214/ajr.21.27159] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Study Protocol for a Trial: A Single-Arm, Open-Labeled Study Evaluating Transcatheter Arterial Embolization Plus Everolimus Combination Therapy for Patients With Liver Metastasis of Gastroenteropancreatic Neuroendocrine Tumors. Clin Med Insights Oncol 2022; 16:11795549221127750. [DOI: 10.1177/11795549221127750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/05/2022] [Indexed: 11/09/2022] Open
Abstract
Background: The number of patients with non-functional neuroendocrine tumors (NETs) has increased recently, and the rate of liver metastasis of NETs is about 20% in patients at the first diagnosis. Transcatheter arterial embolization (TAE) and everolimus are therapies with reported efficacy, but few reports have described their combined treatment. We therefore aim to evaluate the efficacy and safety of combination therapy with everolimus and TAE in patients with liver metastasis of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) in a prospective study. Methods: We design a single-arm, open-label, prospective study to evaluate the efficacy and safety of combination therapy with everolimus and TAE in patients with liver metastases of GEP-NETs. The study started in June 2021 at Okayama University Hospital and is expected to enroll 18 patients over a 2-year period. Discussion: This study is a prospective study investigating a new treatment method for a rare disease called GEP-NETs. We may obtain useful information that contributes to the treatment guidelines in this study. However, NET is a rare disease, and although the number of cases is statistically established, it may not be possible to accurately assess causality. TRIAL REGISTRATION NUMBER: jRCT1061210015.
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Schippers AC, Collettini F, Steffen IG, Wieners G, Denecke T, Pavel M, Wust P, Gebauer B. Initial Experience with CT–Guided High-Dose-Rate Brachytherapy in the Multimodality Treatment of Neuroendocrine Tumor Liver Metastases. J Vasc Interv Radiol 2017; 28:672-682. [DOI: 10.1016/j.jvir.2016.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 07/09/2016] [Accepted: 07/09/2016] [Indexed: 02/07/2023] Open
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Mangano A, Lianos GD, Roukos DH, Mason SE, Kim HY, Dionigi G. New horizons for targeted treatment of neuroendocrine tumors. Future Oncol 2016; 12:1059-65. [PMID: 26916705 DOI: 10.2217/fon.16.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Neuroendocrine tumors (NETs) are rare and heterogeneous tumors and there is a paucity of randomized clinical trials evaluating the different therapeutic strategies. Over recent years, some important molecular aspects have been investigated and multiple targeted therapies are currently available. One of the most promising targets for the therapy of NETs are the mTOR and angiogenic growth factor receptors. The advent of the inhibitors of the mTOR pathway, tyrosine kinase inhibitors and of somatostatin analogs have shown their efficacy in randomized clinical trials in terms of implementing clinical hormone-induced syndromes and progression-free survival of advanced NETs. This article summarizes the standard therapies and new perspectives in NET's treatment, which remains still very heterogeneous and little known entity.
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Affiliation(s)
- Alberto Mangano
- First Department of General Surgery Ospedale di Circolo e Fondazione Macchi Varese, Department of Human Morphology & Surgical Sciences Insubria University Varese-Como, Italy
| | - Georgios D Lianos
- Department of General Surgery Ioannina University Hospital, Centre for Biosystems & Genomic Network Medicine Ioannina University, Ioannina, Greece
| | - Dimitrios H Roukos
- Department of General Surgery Ioannina University Hospital, Centre for Biosystems & Genomic Network Medicine Ioannina University, Ioannina, Greece
| | - Sam E Mason
- ICENI Centre, Turner Road, Colchester, CO4 5JL, UK
| | - Hoon Yub Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Gianlorenzo Dionigi
- First Department of General Surgery Ospedale di Circolo e Fondazione Macchi Varese, Department of Human Morphology & Surgical Sciences Insubria University Varese-Como, Italy
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Tabaksblat EM, Langer SW, Knigge U, Grønbæk H, Mortensen J, Petersen RH, Federspiel BH, Ladekarl M. Diagnosis and treatment of bronchopulmonary neuroendocrine tumours: State of the art. Acta Oncol 2015. [PMID: 26223571 DOI: 10.3109/0284186x.2015.1067715] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Bronchopulmonary neuroendocrine tumours (BP-NET) are a heterogeneous population of neoplasms with different pathology, clinical behaviour and prognosis compared to the more common lung cancers. The management of BP-NET patients is largely based on studies with a low level of evidence and extrapolation of data obtained from more common types of neuroendocrine tumours. This review reflects our view of the current state of the art of diagnosis and treatment of patients with BP-NET.
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Affiliation(s)
| | - Seppo W. Langer
- Department of Oncology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ulrich Knigge
- Departments of Surgery C and Endocrinology PE, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henning Grønbæk
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Jann Mortensen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Hartnack Federspiel
- Department of Pathology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten Ladekarl
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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Bilici A. Advances in the management of unresectable or metastatic pancreatic neuroendocrine tumors: chemotherapy, targeted therapy, hormonal treatment, and future directions. Asian Pac J Cancer Prev 2015; 16:2151-9. [PMID: 25824731 DOI: 10.7314/apjcp.2015.16.6.2151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Pancreatic neuroendocrine tumors (pNETs) are rare and heterogenous tumors and surgery to remove the primary tumor is the mainstay of treatment for resectable disease. However, curative surgery is often not feasible, because half of patients with pNET have metastases at the time of diagnosis. Palliative dubulking surgery and liver-directed therapies are appropriate options for these patients. Streptozocin-based regimens are standard, although temozolamide-based treatments are rapidly gaining wide clinical application. Somatostatin analogs are mainly indicated in hormonally active tumors to ameliorate symptoms. In addition, anti-tumoral activity has been proven in well-differentiated NETs. Recently, there has been tremendous progress in the molecular biology of pNETs; thereby, the efficacy of sunitinib and everolimus in the treatment of patients with metastatic pNETs has been proven by large placebo-controlled phase III trials. Currently, there are no definitively proven predictive biomarkers to evaluate response to medical therapies in patients with pNET. Therefore, further studies are needed to individualize and optimize their management. This article reviews systemic chemotherapy, targeted therapies, and anti-secretory treatments for the management of patients with unresectable or metastatic pNETs, summarized in the light of recent advances.
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Affiliation(s)
- Ahmet Bilici
- Department of Medical Oncology, Istanbul Medipol University, Medical Faculty, Istanbul, Turkey E-mail :
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Simo KA, Tsirline VB, Sindram D, McMillan MT, Thompson KJ, Swan RZ, McKillop IH, Martinie JB, Iannitti DA. Microwave ablation using 915-MHz and 2.45-GHz systems: what are the differences? HPB (Oxford) 2013; 15:991-6. [PMID: 23490330 PMCID: PMC3843618 DOI: 10.1111/hpb.12081] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 01/21/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study was conducted to evaluate differences between 915-MHz and 2.45-GHz microwave ablation (MWA) systems in the ablation of hepatic tumours. METHODS A retrospective analysis of patients undergoing hepatic tumour MWA utilizing two different systems over a 10-month period was carried out. RESULTS Data for a total of 48 patients with a mean age of 58 ± 1.24 years were analysed. A total of 124 tumours were ablated; 72 tumours were ablated with a 915-MHz system and 52 with a 2.45-GHz system. Mean tumour diameters were 1.7 ± 0.1 cm in the 915-MHz group and 2.5 ± 0.2 cm in the 2.45-GHz group (P < 0.01). Mean ablation time per burn was 8.1 ± 0.3 min in the 915-MHz group and 4.0 ± 0.1 min in the 2.45-GHz group (P < 0.01). The mean number of burns per lesion was 2.0 ± 0.1 in the 915-MHz group and 1.7 ± 0.1 in the 2.45-GHz group (P < 0.05). The mean ablation time per lesion was 9.7 ± 0.7 min in the 915-MHz group, and 6.6 ± 0.6 min in the 2.45-GHz group (P < 0.01). The 2.45-GHz system demonstrated a better correlation between ablation time and tumour size (r(2) = 0.6222) than the 915-MHz system; (r(2) = 0.0696). Mean total energy applied per lesion, and energy applied per cm, were greater with the 915-MHz system (P < 0.05 and P < 0.01, respectively). Total energy applied per lesion was similarly correlated for the 2.45-GHz (r(2) = 0.6263) and 915-MHz (r(2) = 0.7012) systems. Mean total energy applied per cm/min was greater with the 2.45-GHz system (P < 0.05). CONCLUSIONS Both 915-MHz and 2.45-GHz MWA systems achieve reproducible hepatic tumour ablation. The 2.45-GHz system achieves equivalent, but more predictable and faster ablations using a single antenna system.
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Affiliation(s)
- Kerri A Simo
- Section of Hepatobiliary and Pancreas Surgery, Carolinas Medical CenterCharlotte, NC, USA
| | - Victor B Tsirline
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Carolinas Medical CenterCharlotte, NC, USA
| | - David Sindram
- Section of Hepatobiliary and Pancreas Surgery, Carolinas Medical CenterCharlotte, NC, USA
| | - Matthew T McMillan
- Section of Hepatobiliary and Pancreas Surgery, Carolinas Medical CenterCharlotte, NC, USA
| | - Kyle J Thompson
- Section of Hepatobiliary and Pancreas Surgery, Carolinas Medical CenterCharlotte, NC, USA
| | - Ryan Z Swan
- Section of Hepatobiliary and Pancreas Surgery, Carolinas Medical CenterCharlotte, NC, USA
| | - Iain H McKillop
- Section of Hepatobiliary and Pancreas Surgery, Carolinas Medical CenterCharlotte, NC, USA
| | - John B Martinie
- Section of Hepatobiliary and Pancreas Surgery, Carolinas Medical CenterCharlotte, NC, USA
| | - David A Iannitti
- Section of Hepatobiliary and Pancreas Surgery, Carolinas Medical CenterCharlotte, NC, USA
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Bisht S, Feldmann G, Brossart P. Pharmacokinetics and pharmacodynamics of sunitinib for the treatment of advanced pancreatic neuroendocrine tumors. Expert Opin Drug Metab Toxicol 2013; 9:777-88. [PMID: 23590356 DOI: 10.1517/17425255.2013.791281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Despite being the second most common malignancy of the pancreas, pancreatic neuroendocrine tumors (PNET) have long been understudied due to their low incidence and heterogeneous clinical presentation. Emerging data from a Phase III trial demonstrates improved progression-free survival of patients with advanced PNET on treatment with sunitinib . AREAS COVERED This article reviews the role of sunitinib, a multitargeted tyrosine kinase inhibitor with potent antiangiogenic and antitumor effects, in the clinical management of PNET. Furthermore, the authors also discuss the pharmacokinetics and pharmacodynamics as well as other clinically relevant aspects regarding sunitinib. EXPERT OPINION A recent Phase III clinical trial of sunitinib demonstrated significant improvement of progression-free survival in patients with advanced or metastatic well-differentiated PNET that led to its approval in several countries, including Europe and United States. This marks a significant step forward in the clinical management of this disease and spurs hopes to further improve overall survival in this once difficult-to-treat set of patients in the coming years. Fields of future interest will include evaluation of combinatorial regimens, including conventional cytotoxic agents as well as additional targeted drugs in order to overcome resistance to sunitinib.
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Affiliation(s)
- Savita Bisht
- University Hospital of Bonn, Department of Internal Medicine 3, Bonn, Germany.
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Boussaha T, Rougier P, Taieb J, Lepere C. Digestive neuroendocrine tumors (DNET): the era of targeted therapies. Clin Res Hepatol Gastroenterol 2013; 37:134-41. [PMID: 23562338 DOI: 10.1016/j.clinre.2012.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 09/23/2012] [Accepted: 09/25/2012] [Indexed: 02/04/2023]
Abstract
Neuroendocrine tumors (NETs) are a heterogeneous group of malignancies. Therapeutic options depend on location of the primitive tumor, its expandability, its hormonal symptoms and its differentiation. Though relatively rare, with an increasing incidence and a high prevalence digestive neuroendocrine tumors (DNETs) are ranked just behind colorectal cancer as the most common digestive cancers in developed countries. Three main therapeutic axes have been individualized in the field of well-differentiated DNETs (corresponding to grades 1 and 2 of new WHO classification 2010), firstly, antitumor activity of somatostatin analogs, particularly in slowly progressive metastatic DNETs with limited hepatic invasion, secondly, targeting angiogenesis in these hypervascular tumors and thirdly targeting the mTOR pathway involved in DNETs carcinogenesis. As a consequence of two major randomized phase III trials in 2011, sunitinib and everolimus have been considered as new therapeutic options for well-differentiated, advanced and progressive pancreatic NETs. For everolimus, another phase III study, although non-significant with the chosen criteria, showed effectiveness notably against small intestine NETs. These targeted therapies are new therapeutic weapons in management of well-differentiated DNETs, but its exact role in care strategy, in comparison with other treatments (somatostatin analogs, chemo-embolization, chemotherapy...) deserves to be precise in the future.
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Affiliation(s)
- Tarek Boussaha
- Service d'hépatogastroentérologie, Groupement Hospitalier Pitié-Salpêtrière, Paris, France
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Coan KE, Gray RJ, Schlinkert RT, Pockaj BA, Wasif N. Metastatic carcinoid tumors--are we making the cut? Am J Surg 2013; 205:642-6. [PMID: 23414634 DOI: 10.1016/j.amjsurg.2012.05.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 05/16/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although controversial, surgical resection for metastatic carcinoid tumors (MCTs) can potentially prolong survival. METHODS Patients with MCTs were identified from the Surveillance, Epidemiology and End Results database. Patients undergoing surgery were compared to unresected patients. RESULTS Surgery was performed in 33% of patients. Predictors of surgery included age <50 years (odds ratio [OR], 2.4), low grade (OR, 3.1), and the appendix (OR, 36.2) or small intestine (OR, 27.2) as the primary site. Predictors of adverse survival included high grade (hazard ratio, 2.4) and no surgery (hazard ratio, 2.5) or surgery on only primary or distant disease (hazard ratio, 1.5) compared with surgery for both. Survival at 5 years was 5% with no surgery, 28% with surgery on either site, and 46% with surgery at both sites (P < .001). CONCLUSIONS Surgery for MCTs is more common in younger patients, those with low-grade disease, and those with small bowel or appendiceal primary tumors. Although selection bias cannot be excluded, these data lend support to "debulking" for MCT.
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Affiliation(s)
- Kathryn E Coan
- Department of Surgery, Mayo Clinic, Phoenix, AZ 85054, USA
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Knigge U, Hansen CP. Surgery for GEP-NETs. Best Pract Res Clin Gastroenterol 2012; 26:819-31. [PMID: 23582921 DOI: 10.1016/j.bpg.2012.12.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 12/27/2012] [Indexed: 01/31/2023]
Abstract
Surgery is the only treatment that may cure the patient with gastroentero-pancreatic (GEP) neuroendocrine tumours (NET) and neuroendocrine carcinomas (NEC) and should always be considered as first line treatment if R0/R1 resection can be achieved. The surgical and interventional procedures for GEP-NET are accordingly described below. Life-long follow-up should be performed in almost all patients at a specialized NET center.
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Affiliation(s)
- Ulrich Knigge
- Department of Gastrointestinal Surgery C, Neuroendocrine Tumor Centre of Excellence, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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12
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Delbaldo C, Faivre S, Dreyer C, Raymond E. Sunitinib in advanced pancreatic neuroendocrine tumors: latest evidence and clinical potential. Ther Adv Med Oncol 2012; 4:9-18. [PMID: 22229044 DOI: 10.1177/1758834011428147] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Based on preclinical data available in the RIP1-Tag2 transgenic mouse model, sunitinib is an inhibitor of angiogenesis in pancreatic neuroendocrine tumors blocking vascular endothelial growth factor receptors and platelet-derived growth factor receptors in endothelial cells and pericytes, respectively. Evidence of objective response in phase I trials justified the initiation of a large phase II/III program using sunitinib in patients with advanced/metastatic well-differentiated pancreatic neuroendocrine tumors. In the phase II study, sunitinib showed potent antitumor activity and a safe toxicity profile. In a recent double-blind placebo-controlled randomized phase III trial, sunitinib doubled the progression-free survival of patients, induced objective responses, and reduced the risk of death of patients with advanced/metastatic well-differentiated tumors. These data allowed the approval of sunitinib in several countries including Europe and the United States of America. These recent data provide hope for patients with well-differentiated pancreatic neuroendocrine tumors and will change standards of care in this disease.
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Affiliation(s)
- Catherine Delbaldo
- Department of Medical Oncology, Univ Paris Diderot, Sorbonne Paris Cité, INSERM U728, and Beaujon and Louis Mourier University Hospital (Assistance Publique Hopitaux de Paris, Paris 7 Diderot), Clichy, France
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13
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Sunitinib in pancreatic neuroendocrine tumors. Target Oncol 2012; 7:117-25. [DOI: 10.1007/s11523-012-0220-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Accepted: 05/04/2012] [Indexed: 02/02/2023]
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Radioguided surgery in neuroendocrine tumors using Ga-68-labeled somatostatin analogs: a pilot study. Clin Nucl Med 2012; 37:142-7. [PMID: 22228336 DOI: 10.1097/rlu.0b013e3182291de8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Previous studies of the intraoperative use of a hand-held gamma probe to localize metastases and primary tumors have shown improved assessment of tumor spread and changes in surgical management based on additional information gained by radioguided surgery (RGS). PURPOSE The aim was to test the feasibility and advantages of doing RGS using a gallium-68 labeled with somatostatin receptor analogs in the intraoperative detection of neuroendocrine tumors. METHODS Ga-68 somatostatin receptor PET/CT imaging was performed preoperatively in 9 patients with gastroenteropancreatic neuroendocrine tumors. Statistical analyses were performed to find out the correlation between the pathologic size of the tumor lesions and the maximum standardized uptake value on PET/CT as well as the target/nontarget ratio (T/NT) of gamma probe counts. Thereafter, the impact of the planned operation procedure and the lesion-based sensitivity of tumor detection (surgical palpation vs. PET/CT vs. gamma probe) had been observed. RESULTS Overall, 72 locations in 9 patients were examined intraoperatively using gamma probes. The gamma probe detected 94% of the whole histologically quantified lesions, whereas the PET/CT allocated 69% and surgical palpation, 50%. RGS resulted in change in the operative procedure in 56%. There was a significant correlation between the maximum standardized uptake value and tumor size (0.74; P < 0.005). CONCLUSION Hand-held gamma probe surgery using gallium-68-labeled somatostatin analogs is a feasible and an attractive option for real-time detection of small metastases and primaries of neuroendocrine tumors.
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Riccardi F, Rizzo M, Festino L, Ambrosio F, Molino C, Uomo G, Cartenì G. Therapy innovation for the treatment of pancreatic neuroendocrine tumors. Expert Opin Ther Targets 2012; 16 Suppl 2:S91-102. [PMID: 22372544 DOI: 10.1517/14728222.2012.665880] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Traditional therapeutic approaches for patients with advanced neuroendocrine tumors (NETs) have included treatment with somatostatin analogs, hepatic-directed therapies, interferon and cytotoxic chemotherapy. Current knowledge about biological behavior of pancreatic neuroendocrine tumors (pNETs) has increased in the last decade, and some studies have been conducted to translate in the clinical setting. Among several molecular agents investigated in patients with progressive pNETs, everolimus and sunitinib have been studied in large Phase III trials. Both have produced significant benefit, with improvement in progression-free survival. These results were published last year by NEJM and were updated at the ASCO Annual Meeting in June 2011. AREAS COVERED This review focuses on the potential molecular targets in pancreatic NETs in the light of recent advances. Furthermore, it summarizes the available data for targeted agents from Phase II and III trials open to patients with this tumor. EXPERT OPINION These new agents are likely to play an increasingly important role in the future management of advanced pNETs. Their use in earlier phases of the disease could improve clinical outcome, avoiding side effects of the more toxic chemotherapy. The challenge in medical treatment of pNET is to define the patients who can benefit from this innovative therapy; future research should be directed to find predictive markers for response to the targeted agent.
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Affiliation(s)
- Ferdinando Riccardi
- UOSC di Oncologia Medica, Gruppo NET Cardarelli, Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, Napoli, Italy.
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Dong M, Phan AT, Yao JC. New strategies for advanced neuroendocrine tumors in the era of targeted therapy. Clin Cancer Res 2012; 18:1830-6. [PMID: 22338018 DOI: 10.1158/1078-0432.ccr-11-2105] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Low- to intermediate-grade neuroendocrine tumor (NET) constitutes a group of indolent malignancies that share the capacity for secreting hormones and neuroamines. Until recently, there were few therapeutic options for oncologic control. The PROMID study showed that octreotide long-acting repeatable formulation can delay tumor growth in midgut NETs. And, recent phase III studies showed both everolimus and sunitinib improved progression-free survival in pancreatic NETs, validating the phosphoinositide 3-kinase/Akt/mTOR pathway and angiogenesis as important targets for further advances. Ongoing and planned pivotal studies targeting these pathways in other NET subtypes may widen their therapeutic application. Development of rational combinations may further improve therapeutic outcome. These successes and our improved understanding of the underlying molecular biology are likely to lead to further important advances on the horizon.
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Affiliation(s)
- Mei Dong
- Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
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Lau KN, Swan RZ, Sindram D, Martinie JB, Iannitti DA. Hepatic tumor ablation: application in a community hospital setting. Surg Oncol Clin N Am 2011; 20:455-66, viii. [PMID: 21640915 DOI: 10.1016/j.soc.2011.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Primary liver tumors are a common clinical problem in the United States and worldwide. Resection has historically been used to treat liver lesions. Commonly used liver-directed therapies include transarterial chemoembolization, selective internal radiation therapy, and ablative therapy. Only ablative therapy can cause direct destruction of the targeted tissue. The commercially available modalities in the United States are all based on thermoablative technology. This article examines the various ablative technologies and their application, as well as how these procedures can be performed safely and with optimal outcomes, in a community cancer center.
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Affiliation(s)
- Kwan N Lau
- Hepato-Pancreato-Biliary Surgery, Department of General Surgery, Carolinas Medical Center, 1025 Morehead Medical Plaza Drive, Suite 300, Charlotte, NC 28204, USA
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Raymond E, Dahan L, Raoul JL, Bang YJ, Borbath I, Lombard-Bohas C, Valle J, Metrakos P, Smith D, Vinik A, Chen JS, Hörsch D, Hammel P, Wiedenmann B, Van Cutsem E, Patyna S, Lu DR, Blanckmeister C, Chao R, Ruszniewski P. Sunitinib malate for the treatment of pancreatic neuroendocrine tumors. N Engl J Med 2011; 364:501-13. [PMID: 21306237 DOI: 10.1056/nejmoa1003825] [Citation(s) in RCA: 1721] [Impact Index Per Article: 132.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The multitargeted tyrosine kinase inhibitor sunitinib has shown activity against pancreatic neuroendocrine tumors in preclinical models and phase 1 and 2 trials. METHODS We conducted a multinational, randomized, double-blind, placebo-controlled phase 3 trial of sunitinib in patients with advanced, well-differentiated pancreatic neuroendocrine tumors. All patients had Response Evaluation Criteria in Solid Tumors-defined disease progression documented within 12 months before baseline. A total of 171 patients were randomly assigned (in a 1:1 ratio) to receive best supportive care with either sunitinib at a dose of 37.5 mg per day or placebo. The primary end point was progression-free survival; secondary end points included the objective response rate, overall survival, and safety. RESULTS The study was discontinued early, after the independent data and safety monitoring committee observed more serious adverse events and deaths in the placebo group as well as a difference in progression-free survival favoring sunitinib. Median progression-free survival was 11.4 months in the sunitinib group as compared with 5.5 months in the placebo group (hazard ratio for progression or death, 0.42; 95% confidence interval [CI], 0.26 to 0.66; P<0.001). A Cox proportional-hazards analysis of progression-free survival according to baseline characteristics favored sunitinib in all subgroups studied. The objective response rate was 9.3% in the sunitinib group versus 0% in the placebo group. At the data cutoff point, 9 deaths were reported in the sunitinib group (10%) versus 21 deaths in the placebo group (25%) (hazard ratio for death, 0.41; 95% CI, 0.19 to 0.89; P=0.02). The most frequent adverse events in the sunitinib group were diarrhea, nausea, vomiting, asthenia, and fatigue. CONCLUSIONS Continuous daily administration of sunitinib at a dose of 37.5 mg improved progression-free survival, overall survival, and the objective response rate as compared with placebo among patients with advanced pancreatic neuroendocrine tumors. (Funded by Pfizer; ClinicalTrials.gov number, NCT00428597.).
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Affiliation(s)
- Eric Raymond
- Service Inter-Hospitalier de Cancérologie et Service de Gastroenteropancréatologie, Hôpital Beaujon, Clichy, France.
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Andreano A, Meneghel E, Bovo G, Ippolito D, Salvioni A, Filice C, Sironi S, Meloni M. Contrast-enhanced ultrasound in planning thermal ablation of liver metastases: Should the hypervascular halo be included in the ablation volume?(). J Ultrasound 2010; 13:158-63. [PMID: 23397004 PMCID: PMC3553109 DOI: 10.1016/j.jus.2010.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Liver metastases often exhibit a hypervascular halo during the arterial phase of contrast-enhanced ultrasonography (CEUS). This finding has no correlates on baseline gray-scale imaging, and it has never been characterized. The aim of this study was to identify the features of this halo and determine whether it should be included in the ablation volume during thermal ablation procedures. MATERIALS AND METHODS We prospectively enrolled 25 patients referred to our department for thermal ablation of liver metastases. Before treatment all patients underwent CEUS, and the maximum diameter of the metastatic lesion was measured before administration of the ultrasound contrast agent and during the arterial and portal venous phases of the contrast contrast-enhanced study. Maximum diameters in the different vascular phases were compared with the Turkey-Kramer test. Two biopsies were obtained from each lesion with a 21-gauge needle: 1) one from the center of the metastasis to confirm the diagnosis and 2) one from the hypervascular peripheral halo identified in the arterial phase at CEUS. RESULTS The mean (±standard deviation) maximum lesion diameter was 2.67 ± 1.2 cm before contrast agent injection, 3.50 ± 1.4 cm during the arterial phase, and 2.71 ± 1.2 cm during the venous phase. The difference between maximum diameters measured before contrast enhancement and in the arterial phase was highly significant (mean: 0.84 ± 0.45 cm, p < 0.0001). Histological examination of halo specimens revealed inflammatory infiltrates with no evidence of tumor infiltration in 24/25 (96%) cases and normal hepatic parenchymal tissue in the 25th specimen. DISCUSSION The hypervascular halo surrounding liver metastases during the arterial phase of CEUS represents a chronic inflammatory infiltrate, not tumor infiltration. However, since chronic inflammation appears to promote neovascularization and the production of tumoral growth factors, it seems wise to include the hypervascular halo in the intended-to-treat volume when planning the ablation procedure.
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Affiliation(s)
- A. Andreano
- Radiodiagnostics Department, Bicocca University of Milan, Italy
- Department of Radiology, San Gerardo Hospital, Monza, Italy
- Corresponding author. Università degli Studi Milano Bicocca, Dipartimento di Radiodiagnostica, Ospedale San Gerardo dei Tintori, Via Pergolesi 33, 20052 Monza, Italy.
| | - E. Meneghel
- Department of Radiology, Bassini Hospital, Cinisello Balsamo, Milan, Italy
| | - G. Bovo
- Department of Anatomic Pathology, San Gerardo Hospital, Monza, Italy
| | - D. Ippolito
- Radiodiagnostics Department, Bicocca University of Milan, Italy
- Department of Radiology, San Gerardo Hospital, Monza, Italy
| | - A. Salvioni
- Department of Internal Medicine, Bassini Hospital, Cinisello Balsamo, Milan, Italy
| | - C. Filice
- Department of Infectious and Tropical Diseases, IRCCS Policlinico San Matteo, Pavia, Italy
| | - S. Sironi
- Radiodiagnostics Department, Bicocca University of Milan, Italy
- Department of Radiology, San Gerardo Hospital, Monza, Italy
| | - M.F. Meloni
- Radiodiagnostics Department, Bicocca University of Milan, Italy
- Department of Radiology, San Gerardo Hospital, Monza, Italy
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Faivre S, Sablin MP, Dreyer C, Raymond E. Novel anticancer agents in clinical trials for well-differentiated neuroendocrine tumors. Endocrinol Metab Clin North Am 2010; 39:811-26. [PMID: 21095547 DOI: 10.1016/j.ecl.2010.09.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Neuroendocrine tumors (NETs) are rare malignancies that arise from endocrine cells located in various anatomic locations, with a dramatic increase in incidence during the last 30 years. Limited therapeutic options are currently available for patients with advanced well-differentiated NETs, including carcinoids and pancreatic NETs. Streptozotocin-based chemotherapy and somatostatin analogues are drugs that are currently used for the treatment of progressive metastatic NETs. Recently, sunitinib demonstrating efficacy in pancreatic islet cell carcinomas has opened a new avenue for the treatment of NETs, and further trials shall be considered in NET types such as carcinoids, poorly differentiated neuroendocrine carcinomas, and several other endocrine tumors that depend on vascular endothelial growth factor (VEGF)/VEGF receptor for angiogenesis. In addition, drugs with distinct mechanisms of action, such as mammalian target of rapamycin inhibitors, currently investigated in phase 3 trials, may also supply novel options to control tumor growth and metastasis. Although acknowledged as rare tumors, recent data demonstrated the feasibility of large randomized trials in this disease. Furthermore, data from large trials also showed the importance of selecting an appropriate patient population when designing randomized studies. This review focuses on novel therapeutic approaches in the treatment of well-differentiated NETs. Based on recent data, novel strategies may now be designed using those anticancer agents to optimize the current treatment of patients with NETs.
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Affiliation(s)
- Sandrine Faivre
- Department of Medical Oncology, Beaujon University Hospital (AP-HP, Paris 7 Diderot), Clichy, France
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Cao CQ, Yan TD, Bester L, Liauw W, Morris DL. Radioembolization with yttrium microspheres for neuroendocrine tumour liver metastases. Br J Surg 2010; 97:537-43. [DOI: 10.1002/bjs.6931] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Background
90Y microsphere radioembolization is performed by injecting the microspheres through a hepatic artery catheter placed percutaneously via the femoral or brachial artery. This study assessed the efficacy of 90Y microsphere therapy for patients with unresectable neuroendocrine tumour liver metastases (NETLMs). Potential prognostic factors were analysed for their impact on overall survival.
Methods
A prospectively collected database for patients with NETLMs treated by 90Y microspheres in two centres from 2003 to 2008 was examined retrospectively. Serial radiographic evidence was collected during follow-up to assess response.
Results
Fifty-eight patients were included, 51 of whom had evaluable disease at most recent follow-up. Six patients achieved a complete response, 14 a partial response, 14 had stable disease and 17 had disease progression. Overall survival rates at 1, 2 and 3 years were 86, 58 and 47 per cent respectively; median survival was 36 (range 1–61) months. Extent of tumour involvement, radiographic response to treatment, extrahepatic disease and tumour grade were significant prognostic factors for overall survival.
Conclusion
90Y microsphere radioembolization achieved a radiographic response in a significant proportion of patients with NETLMs.
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Affiliation(s)
- C Q Cao
- Department of Surgery, University of New South Wales, St George Hospital, Sydney, Australia
| | - T D Yan
- Department of Surgery, University of New South Wales, St George Hospital, Sydney, Australia
| | - L Bester
- Department of Interventional Radiology, University of New South Wales, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - W Liauw
- Department of Oncology, University of New South Wales, St George Hospital, Sydney, Australia
| | - D L Morris
- Department of Surgery, University of New South Wales, St George Hospital, Sydney, Australia
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22
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Padma S, Martinie JB, Iannitti DA. Liver tumor ablation: percutaneous and open approaches. J Surg Oncol 2010; 100:619-34. [PMID: 20017157 DOI: 10.1002/jso.21364] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The global incidence of liver cancer is greater than a million cases a year. Surgical resection where applicable is still the standard of care for these patients. Various liver-directed regional therapies have been developed in an effort to treat the vast majority of unresectable liver tumors. This article reviews the principles behind various ablation therapies currently available for malignant liver tumors and their outcomes.
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Affiliation(s)
- Srikanth Padma
- Section of Hepato-Pancreatico-Biliary Surgery, Division of GI & Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina 28203, USA
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Clinical Experience in Surgical Treatment of Gastrointestinal Neuroendocrine Tumors. POLISH JOURNAL OF SURGERY 2010. [DOI: 10.2478/v10035-010-0029-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Neuroendocrine malignancies encompass a variety of tumors that differ considerably in origin, hormonal activity, and biological behavior. Because of their rarity most therapeutic recommendations have been based on limited evidence from small retrospective series observing miscellaneous patient cohorts. Only in recent years proposals for TNM and histological grading systems have been elaborated that allow further stratification of patients suffering from these tumors. Especially patients with well and moderately differentiated neuroendocrine malignancies benefit from resection of liver metastases, improving the 5-year survival rate from <50% to 80%. Orthotopic liver transplantation can likewise improve survival in carefully selected patients. New developments in imaging modalities, intensive care treatment, and in liver surgery itself have broadened the selection of potentially resectable tumors.
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Pezzilli R, Ricci C, Serra C, Casadei R, Monari F, D’Ambra M, Corinaldesi R, Minni F. Current medical treatment of pancreatic neuroendocrine tumors. Cancers (Basel) 2007; 2:1419-31. [PMID: 24281165 PMCID: PMC3837314 DOI: 10.3390/cancers2031419] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 06/28/2010] [Accepted: 06/30/2010] [Indexed: 02/07/2023] Open
Abstract
Pancreatic neuroendocrine tumors (NETs) consist of a wide group of neoplasms, with different biological behaviors in terms of aggressiveness and hormone production. In the last two decades, significant progress has been observed in our understanding of their biology, diagnosis and treatment. Surgery remains to be the only curative approach, but unfortunately the diagnosis is often delayed due to the slow growth of these tumors and the difficulty in identifying the symptoms related to the tumor-released hormones. In addition to surgery, other approaches to control the disease are biological therapy consisting of somatostatin analogs and interferon (IFN), systemic chemotherapy, radioligand therapy and local therapy with chemoembolization. Several newer cytotoxic agents, including irinotecan, gemcitabine, taxanes, oxaliplatin, capecitabine and PS-341 have been studied in metastatic patients. Considering the high vascularity of these tumors, antiangiogenic agents like endostatin and thalidomide have also been evaluated in advanced NETs. Although these agents seem to have potential activity in NETs and may increase progression free survival, none of these currently available medical therapeutic options are curative. While more efficient novel strategies are to be developed, the rationale use of the current therapeutic options may improve quality of life, control the symptoms related to the hypersecretion of hormones and/or peptides, control tumor proliferation and prolong survival in patients suffering from NETs.
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Affiliation(s)
- Raffaele Pezzilli
- Department of Internal Medicine and Gastroenterology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; E-Mail: (C.S.); (R.C.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +39-051-636-4148
| | - Claudio Ricci
- Department of Surgery, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; E-Mails: (C.R.); (R.C.); (F.M.); (M.D’A.); (F.M.)
| | - Carla Serra
- Department of Internal Medicine and Gastroenterology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; E-Mail: (C.S.); (R.C.)
| | - Riccardo Casadei
- Department of Surgery, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; E-Mails: (C.R.); (R.C.); (F.M.); (M.D’A.); (F.M.)
| | - Francesco Monari
- Department of Surgery, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; E-Mails: (C.R.); (R.C.); (F.M.); (M.D’A.); (F.M.)
| | - Marielda D’Ambra
- Department of Surgery, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; E-Mails: (C.R.); (R.C.); (F.M.); (M.D’A.); (F.M.)
| | - Roberto Corinaldesi
- Department of Internal Medicine and Gastroenterology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; E-Mail: (C.S.); (R.C.)
| | - Francesco Minni
- Department of Surgery, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; E-Mails: (C.R.); (R.C.); (F.M.); (M.D’A.); (F.M.)
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