1
|
Prinzi N, Raimondi A, Maccauro M, Milione M, Garanzini E, Torchio M, Corti F, Nichetti F, Lo Russo G, Giacomelli L, Mazzaferro V, Di Bartolomeo M, Seregni E, de Braud F, Pusceddu S. Somatostatin analogs in association with peptide receptor radionucleotide therapy in advanced well-differentiated NETs. Future Oncol 2019; 15:3015-3024. [PMID: 31424273 DOI: 10.2217/fon-2019-0138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Data from 69 well-differentiated gastroenteropancreatic neuroendocrine tumors treated with peptide receptor radionucleotide therapy + somatostatin analogs (SSAs) after SSA treatment failure were evaluated. Methods: We identified two groups: S1 - patients who kept the same SSA treatment beyond progression; S2 - patients who switched the SSA with another SSA after progression. Results: Median progression-free survival was 53 and 127 months in S1 and S2, respectively (p = 0.001; hazard ratio: 0.31; 95% CI: 0.15-0.63). Median overall survival was 69 versus 150 months in S1 and S2, respectively (p = 0.004; hazard ratio: 0.32; 95% CI: 0.14-0.71). Conclusion: In patients with advanced well-differentiated gastroenteropancreatic neuroendocrine tumors treated with peptide receptor radionucleotide therapy plus SSA after SSA failure, the 'switch' strategy of SSA after progression improve progression-free survival and overall survival.
Collapse
Affiliation(s)
- Natalie Prinzi
- Fondazione IRCCS Istituto Nazionale Tumori Milano, ENETS Center of Excellence, Department of Medical Oncology, Milan, Italy
| | - Alessandra Raimondi
- Fondazione IRCCS Istituto Nazionale Tumori Milano, ENETS Center of Excellence, Department of Medical Oncology, Milan, Italy
| | - Marco Maccauro
- Fondazione IRCCS Istituto Nazionale Tumori Milano, ENETS Center of Excellence, Department of Medical Oncology, Milan, Italy
| | - Massimo Milione
- Fondazione IRCCS Istituto Nazionale Tumori Milano, ENETS Center of Excellence, Department of Medical Oncology, Milan, Italy
| | - Enrico Garanzini
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Martina Torchio
- Fondazione IRCCS Istituto Nazionale Tumori Milano, ENETS Center of Excellence, Department of Medical Oncology, Milan, Italy
| | - Francesca Corti
- Fondazione IRCCS Istituto Nazionale Tumori Milano, ENETS Center of Excellence, Department of Medical Oncology, Milan, Italy
| | - Federico Nichetti
- Fondazione IRCCS Istituto Nazionale Tumori Milano, ENETS Center of Excellence, Department of Medical Oncology, Milan, Italy
| | - Giuseppe Lo Russo
- Fondazione IRCCS Istituto Nazionale Tumori Milano, ENETS Center of Excellence, Department of Medical Oncology, Milan, Italy
| | - Luca Giacomelli
- Fondazione IRCCS Istituto Nazionale Tumori Milano, ENETS Center of Excellence, Department of Medical Oncology, Milan, Italy
| | - Vincenzo Mazzaferro
- Fondazione IRCCS Istituto Nazionale Tumori Milano, ENETS Center of Excellence, Department of Medical Oncology, Milan, Italy
| | - Maria Di Bartolomeo
- Fondazione IRCCS Istituto Nazionale Tumori Milano, ENETS Center of Excellence, Department of Medical Oncology, Milan, Italy
| | - Ettore Seregni
- Fondazione IRCCS Istituto Nazionale Tumori Milano, ENETS Center of Excellence, Department of Medical Oncology, Milan, Italy
| | - Filippo de Braud
- Fondazione IRCCS Istituto Nazionale Tumori Milano, ENETS Center of Excellence, Department of Medical Oncology, Milan, Italy
| | - Sara Pusceddu
- Fondazione IRCCS Istituto Nazionale Tumori Milano, ENETS Center of Excellence, Department of Medical Oncology, Milan, Italy
| |
Collapse
|
2
|
Kang XN, Zhang XY, Bai J, Wang ZY, Yin WJ, Li L. Analysis of B-ultrasound and contrast-enhanced ultrasound characteristics of different hepatic neuroendocrine neoplasm. World J Gastrointest Oncol 2019; 11:436-448. [PMID: 31139313 PMCID: PMC6522763 DOI: 10.4251/wjgo.v11.i5.436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/19/2019] [Accepted: 03/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hepatic neuroendocrine neoplasm (hNEN) is a highly heterogeneous tumor. The exact identification of the source and malignant degree of hNEN is important. However, there is a lack of information regarding diagnosis of hNEN with imaging. In addition, no studies have compared the imaging between hNEN and hepatocellular carcinoma (HCC) and among different sources and malignant degrees of hNEN.
AIM To compare the ultrasound characteristics between hNEN and HCC and among different sources and malignant degrees of hNEN.
METHODS A total of 55 patients with hNEN were recruited and defined as the hNEN group. Among them, 35 cases of hNET were defined as the hNET group. Twenty cases of hepatic neuroendocrine carcinoma (hNEC) were defined as the hNEC group. Among the 55 lesions, 29 were transferred from the pancreas, 20 were from the gastrointestinal tract, and six were from other sites. In total, 55 patients with HCC were recruited and defined as the HCC group. The characteristic differences of B-mode ultrasound and contrast-enhanced ultrasound (CEUS) between hNEN and HCC and among different sources and malignant degrees of hNEN were compared.
RESULTS In the hNEN group, the proportions of multiple liver lesions, unclear borders, and high echo lesions were higher than those in the HCC group. The proportions of non-uniform echo and peripheral acoustic halo were lower than those in the HCC group (P < 0.05). The washout to iso-enhancement time and washout to hypo-enhancement time were lower than those in the HCC group (P < 0.05). The characteristics of B-ultrasound and CEUS among different sources of hNEN were similar, and the differences were not statistically significant (P > 0.05). B-mode ultrasound characteristics of hNET and hNEC were similar. The proportions of low enhancement at portal venous phase, non-uniform enhancement forms, and combined tumor vasculature in the hNEC group were larger than those in the hNEN group (P < 0.05).
CONCLUSION Compared with HCC, hNEN showed multiple intrahepatic lesions, uniform high echo, uniform high enhancement at arterial phase, and rapid washout. Low enhancement at portal venous phase, overall non-uniform enhancement form, and the proportion of combined tumor vasculature in hNEC were larger than those in hNET.
Collapse
Affiliation(s)
- Xiao-Ning Kang
- Department of Second Ultrasound, Cangzhou Central Hospital, Cangzhou 061001, Hebei Province, China
| | - Xiao-Yu Zhang
- Department of Third Oncology, Cangzhou Central Hospital, Cangzhou 061001, Hebei Province, China
| | - Jie Bai
- Department of Third Oncology, Cangzhou Central Hospital, Cangzhou 061001, Hebei Province, China
| | - Zun-Yi Wang
- Department of Third Oncology, Cangzhou Central Hospital, Cangzhou 061001, Hebei Province, China
| | - Wen-Jie Yin
- Department of Gastroenterology, Cangzhou Central Hospital, Cangzhou 061001, Hebei Province, China
| | - Li Li
- Department of Second Ultrasound, Cangzhou Central Hospital, Cangzhou 061001, Hebei Province, China
| |
Collapse
|
3
|
Barazeghi E, Prabhawa S, Norlén O, Hellman P, Stålberg P, Westin G. Decrease of 5-hydroxymethylcytosine and TET1 with nuclear exclusion of TET2 in small intestinal neuroendocrine tumors. BMC Cancer 2018; 18:764. [PMID: 30045709 PMCID: PMC6060499 DOI: 10.1186/s12885-018-4579-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 06/07/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Small intestinal neuroendocrine tumors (SI-NETs) originate from enterochromaffin cells scattered in the intestinal mucosa of the ileum and jejunum. Loss of one copy of chromosome 18 is the most frequent observed aberration in primary tumors and metastases. The aim of this study was to investigate possible involvement of 5-hydroxymethylcytosine (5hmC), TET1 and TET2 in SI-NETs. METHODS The analysis was conducted using 40 primary tumors and corresponding 47 metastases. The level of 5hmC, TET1 and TET2 was analyzed by DNA immune-dot blot assay and immunohistochemistry. Other methods included a colony forming assay, western blotting analysis, and quantitative bisulfite pyrosequencing analysis. The effect of the exportin-1 nuclear transport machinery inhibitors on cell proliferation and apoptosis was also explored using two SI-NET cell lines. RESULTS Variable levels of 5hmC and a mosaic staining appearance with a mixture of positive and negative cell nuclei, regardless of cell number and staining strength, was observed overall both in primary tumors and metastases. Similarly aberrant staining pattern was observed for TET1 and TET2. In a number of tumors (15/32) mosaic pattern together with areas of negative staining was also observed for TET1. Abolished expression of TET1 in the tumors did not seem to involve hypermethylation of the TET1 promoter region. Overexpression of TET1 in a colony forming assay supported a function as cell growth regulator. In contrast to 5hmC and TET1, TET2 was also observed in the cytoplasm of all the analyzed SI-NETs regardless of nuclear localization. Treatment of CNDT2.5 and KRJ-I cells with the exportin-1 (XPO1/CRM1) inhibitor, leptomycin B, induced reduction in the cytoplasm and nuclear retention of TET2. Aberrant partitioning of TET2 from the nucleus to the cytoplasm seemed therefore to involve the exportin-1 nuclear transport machinery. Reduced cell proliferation and induction of apoptosis were observed after treatment of CNDT2.5 and KRJ-I cells with leptomycin B or KPT-330 (selinexor). CONCLUSIONS SI-NETs are epigenetically dysregulated at the level of 5-hydroxymethylcytosine/ TET1/TET2. We suggest that KPT-330/selinexor or future developments should be considered and evaluated for single treatment of patients with SI-NET disease and also in combinations with somatostatin analogues, peptide receptor radiotherapy, or everolimus.
Collapse
Affiliation(s)
- Elham Barazeghi
- Department of Surgical Sciences, Uppsala University, Uppsala University Hospital, Rudbeck Laboratory, SE-751 85, Uppsala, Sweden
| | - Surendra Prabhawa
- Department of Surgical Sciences, Uppsala University, Uppsala University Hospital, Rudbeck Laboratory, SE-751 85, Uppsala, Sweden
| | - Olov Norlén
- Department of Surgical Sciences, Uppsala University, Uppsala University Hospital, Rudbeck Laboratory, SE-751 85, Uppsala, Sweden
| | - Per Hellman
- Department of Surgical Sciences, Uppsala University, Uppsala University Hospital, Rudbeck Laboratory, SE-751 85, Uppsala, Sweden
| | - Peter Stålberg
- Department of Surgical Sciences, Uppsala University, Uppsala University Hospital, Rudbeck Laboratory, SE-751 85, Uppsala, Sweden.
| | - Gunnar Westin
- Department of Surgical Sciences, Uppsala University, Uppsala University Hospital, Rudbeck Laboratory, SE-751 85, Uppsala, Sweden.
| |
Collapse
|
4
|
Mantzoros I, Savvala NA, Ioannidis O, Parpoudi S, Loutzidou L, Kyriakidou D, Cheva A, Intzos V, Tsalis K. Midgut neuroendocrine tumor presenting with acute intestinal ischemia. World J Gastroenterol 2017; 23:8090-8096. [PMID: 29259385 PMCID: PMC5725304 DOI: 10.3748/wjg.v23.i45.8090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/05/2017] [Accepted: 10/26/2017] [Indexed: 02/06/2023] Open
Abstract
Neuroendocrine tumors represent a heterogeneous group of neoplasms that arise from neuroendocrine cells and secrete various peptides and bioamines. While gastrointestinal neuroendocrine tumors, commonly called carcinoids, account for about 2/3 of all neuroendocrine tumors, they are relatively rare. Small intestine neuroendocrine tumors originate from intestinal enterochromaffin cells and represent about 1/4 of small intestine neoplasms. They can be asymptomatic or cause nonspecific symptoms, which usually leads to a delayed diagnosis. Imaging modalities can aid diagnosis and surgery remains the mainstay of treatment. We present a case of a jejunal neuroendocrine tumor that caused nonspecific symptoms for about 1 year before manifesting with acute mesenteric ischemia. Abdominal X-rays revealed pneumatosis intestinalis and an abdominal ultrasound and computed tomography confirmed the diagnosis. The patient was submitted to segmental enterectomy. Histopathological study demonstrated a neuroendocrine tumor with perineural and arterial infiltration and lymph node metastasis. The postoperative course was uneventful and the patient denied any adjuvant treatment.
Collapse
Affiliation(s)
- Ioannis Mantzoros
- Fourth Surgical Department, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital, Thessaloniki 57010, Greece
| | - Natalia Antigoni Savvala
- Fourth Surgical Department, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital, Thessaloniki 57010, Greece
| | - Orestis Ioannidis
- Fourth Surgical Department, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital, Thessaloniki 57010, Greece
| | - Styliani Parpoudi
- Fourth Surgical Department, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital, Thessaloniki 57010, Greece
| | - Lydia Loutzidou
- Fourth Surgical Department, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital, Thessaloniki 57010, Greece
| | - Despoina Kyriakidou
- Fourth Surgical Department, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital, Thessaloniki 57010, Greece
| | - Angeliki Cheva
- Department of Pathology, General Hospital “G. Papanikolaou”, Thessaloniki 57010, Greece
| | - Vasileios Intzos
- Department of Radiology, General Hospital “G. Papanikolaou”, Thessaloniki 57010, Greece
| | - Konstantinos Tsalis
- Fourth Surgical Department, Faculty of Health Science, School of Medicine, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital, Thessaloniki 57010, Greece
| |
Collapse
|