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An Update on the Management of Mixed Neuroendocrine-Non-neuroendocrine Neoplasms (MiNEN)

  • Neuroendocrine Cancers (M Cives, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

The classification of mixed neuroendocrine-non-neuroendocrine neoplasms (MiNEN) is evolving, and no clear management guidelines are currently available. However, recent studies provide insight into factors affecting outcomes and could help develop treatment decisions for patients with these rare malignancies. The majority of MiNENs have a poorly differentiated neuroendocrine carcinoma (NEC) component which is associated with an aggressive clinical course and poor outcomes. Due to the paucity of clinical trials, strategies adopted in gastrointestinal cancers and NECs are used to manage MiNENs. It is also to be noted that the thoracic neuroendocrine neoplasm WHO 2021 classification does not recognize MiNEN terminology but suggests an equivalent terminology called “combined neuroendocrine non neuroendocrine neoplasm.” Surgical management is appropriate in early-stage disease with a low threshold for addition of adjuvant chemotherapy. Multimodality treatment with chemotherapy offers a survival benefit in advanced disease or when surgical resection is not possible without significant morbidity. Chemotherapy should be directed at the more aggressive component which is often the NEC component. In addition, molecular testing should be employed to evaluate patients for enrollment in clinical trials and other targeted treatments. Being a rare disease with retrospective studies and case series providing the majority of data on treatment selection, it is essential to include more granular details of pathology (e.g., Ki-67, mitotic index, percentage of each component, staging information) and treatment modalities (e.g., type and duration, rationale, radiologic response, survival outcomes) in future studies to make systematic reviews possible and help derive meaningful conclusions.

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Authors and Affiliations

  1. Department of Internal Medicine, Pikeville Medical Center, Pikeville, KY, USA

    Aasems Jacob MD & Rishi Raj MD

  2. Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, KY, USA

    Derek B. Allison MD

  3. Department of Urology, University of Kentucky, Lexington, KY, USA

    Derek B. Allison MD

  4. Huntsman Cancer Center, University of Utah, Salt Lake City, UT, USA

    Heloisa P. Soares MD

  5. Division of Medical Oncology, Department of Internal Medicine, University of Kentucky, 800 Rose Street, CC447, Lexington, KY, 40536, USA

    Aman Chauhan MD

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Aasems Jacob declares that he has no conflict of interest. Rishi Raj declares that he has no conflict of interest. Derek B Allison declares that he has no conflict of interest. Heloisa P Soares declares that she has no conflict of interest. AC is advisor for Novartis, TerSera, Ipsen, and Lexicon. AC has also received research support from BMS, Clovis Oncology, TerSera, ECS Progastrin, EMD Serono, and Nanopharmaceuticals.

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Jacob, A., Raj, R., Allison, D.B. et al. An Update on the Management of Mixed Neuroendocrine-Non-neuroendocrine Neoplasms (MiNEN). Curr. Treat. Options in Oncol. 23, 721–735 (2022). https://doi.org/10.1007/s11864-022-00968-y

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