Abstract
Neuroendocrine tumours (NET) are a rare and heterogeneous group of tumours. Over two-thirds originate from the gastrointestinal tract, and others include lung, breast, ovary and prostate (Modlin IM, Lye KD, Kidd M: Cancer 97(4):934–959, 2003). In 11–14% of cases the primary site is unknown [Hauso O, Gustafsson BI, Kidd M, Waldum HL, Drozdov I, Ak C et al: Cancer 113(10):2655–2664, 2008]. NET are classified according to their tissue origin, biochemical behavior, and prognosis (Ahlman H, Wängberg B, Jansson S, Friman S, Olausson M, Tylen U et al: Digestion 62:59–68, 2012). Functional tumours secrete bioactive peptides and may lead to the development of symptoms including flushing, wheezing, abdominal cramps, diarrhoea, blood pressure disturbance and tachycardia (Dong M, Phan T, Yao JC: Clin Cancer Res 18:1830–1836, 2012). Investigations include measurement of 24-h urinary 5-HIAA and chromogranin A. Management is dependent on symptoms at presentation, site of disease and tumour grade. Treatments include surgery for localised disease, ablative therapy, somatostatin analogues, chemotherapy and biological targeted therapy for advanced disease. Most patients present with advanced disease and in patients with metastatic disease median survival is around 24–27 months.
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References
Modlin IM, Lye KD, Kidd M (2003) A 5-decade analysis of 13,715 carcinoid tumours. Cancer 97(4):934–959
Hauso O, Gustafsson BI, Kidd M, Waldum HL, Drozdov I, Ak C et al (2008) Neuroendocrine tumur epidemiology: constrasting Normway and North America. Cancer 113(10):2655–2664
Ahlman H, Wängberg B, Jansson S, Friman S, Olausson M, Tylen U et al (2012) Interventional treatment of gastrointestinal neuroendocrine tumours. Digestion 62:59–68
Dong M, Phan T, Yao JC (2012) New strategies for advanced Neuroendocrine tumours in the era of targeted therapy. Clin Cancer Res 18:1830–1836
Solorzano CC, Lee JE, Pisters PW, Vauthey JN, Ayers GD, Jean ME et al (2001) Nonfunctioning islet cell carcinoma of the pancreas: Survival results in a contemporary series of 163 patients. Surgery 130(6):1078–1085
Taal BG, Visser O (2004) Epidemiology of Neuroendocrine tumours. Neuroendocrinology 80(1):3–7
Yao JC, Hassan MM, Phan A, Dagohoy C, Leary C, Mares JE et al (2008) One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 26(18):3063–3072
Hassan MM, Phan A, Li D, Dagohoy CG, Leary C, Yao JC (2008) Risk factors associated with neuroendocrine tumours: a US based case controlled study. Int J Cancer 123:867–873
Larsson C, Skogseid B, Oberg K, Nakamura Y, Nordenskjöld MS (1988) Multiple endocrine neoplasia type 1 gene maps to chromosome 11 and is lost in insulinoma. Nature 332(6159):85–87
Chandrasekharappa SC, Guru SC, Manickam P, Olufemi SE, Collins FS, Emmert-Buck MR et al (1997) Positional cloning of the gene for multiple endocrine neoplasia-type 1. Science 276(531):404–407
Mulligan LM, Kwok JB, Healey CS, Elsdon MJ, Eng C, Gardner E et al (1993) Germ-line mutations of the RET proto-oncogene in multiple endocrine neoplasia type 2A. Nature 363:458–460
Donis-Keller H, Dou S, Chi D, Carlson KM, Toshima K (1993) Lairmore TCet al. Mutations in the RET proto-oncogene are associated with MEN2A and FMTC. Hum Mol Genet 2:851–856
Ledbetter DH, Rich DC, O’Connell P, Leppert M, Carey JC (1989) Precise localization of NF1 to 17q11.2 by balanced translocation. Am J Hum Genet 44(1):58–67
Kaltsas GA, Besser MG, Grossman AB (2004) The diagnosis and medical management of advanced neuroendocrine tumors. Endocr Rev 25(3):458–511
Ramage JK, Ahmed A, Ardill J, Bax N, Breen DJ, Caplin ME (2012) Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumors (NETs). Int J Gastroenterol Hepatol 61:6–32
Oberg K, Castellano D (2011) Current knowledge on diagnosis and staging of neuroendocrine tumors. Cancer Metastasis Rev 30(1):3–7
Kulke MH, Anthony LB, Bushnell DL, deHerder WW, Goldsmith SJ, Klimstra DS (2010) NANETS treatment guidelines: well-differentiated neuroendocrine tumors of the stomach and pancreas. Pancreas 39:735–752
Klimstra DS, Modlin IR, Coppola D, Lloyd RV, Suster S (2010) The pathologic classification of neuroendocrine tumors: a review of nomenclature, grading, and staging systems. Pancreas 39:707–712
Stephenson TJ, Cross S, Chetty R (2012) Dataset for neuroendocrine tumours of the gastrointestinal tract including pancreas, 3rd edn. September 2012. Royal College of Pathologists
Salazar R, Wiedenmann B, Rindi G, Ruszniewski P (2012) ENETS 2011 consensus guidelines for the diagnosis and treatment of neuroendocrine tumors. Neuroendocrinology 95:71–176
Tang LH, Shia J, Soslow RA, Dhall D, Wong WD, O’Reilly E et al (2008) Pathologic classification and clinical behaviour of the spectrum of goblet cell carcinoid tumors of the appendix. Am J Surg Pathol 32:1429–1443
Caplin ME, Buscombe JR, Hilson AJ, Jones AL, Watkinson AF, Burroughs AK (1998) Carcinoid tumour. Lancet 352:799–805
Fox DJ, Khattar RS (2004) Carcinoid heart disease: presentation, diagnosis, and management. Heart 90(10):1224–1228
Wermers RA, Fatourechi V, Wynne AG, Kvols LK, Lloyd RV (1996) The glucagonoma syndrome. Clinical and pathologic features in 21 patients. Medicine 75(2):53–63
Panzuto F, Nasoni S, Falconi M, Corleto VD, Capurso G, Cassetta S et al (2005) Prognostic factors and survival in endocrine tumor patients: comparison between gastrointestinal and pancreatic localization. Endocr Relat Cancer 12(4):1083–1092
Pirker RA, Point J, Pohnl R (1998) Usefulness of chromagranin A as a marker for detection of relapses of carcinoid tumours. Clin Chem Lab Med 36:387–840
Eriksson B, Kloppel G, Krenning E, Ahlman H, Plockinger U, Wiedenmann B et al (2008) Consensus guidelines for the management of patients with patients with digestive neuroendocrine well differentiated jejunal-ileal tumour/carcinoma. Neuroendocrinology 87:8–19
Gabriel M, Decristoforo C, Kendler D, Dobrozemsky G, Heute D, Uprimny C et al (2007) 68Ga-DOTA-Tyr3-octreotide PET in neuroendocrine tumours: comparison with somatostatin receptor scintigraphy and CT. J Nucl Med 48:508–518
Detjen KM, Welzel M, Farwig K, Brembeck FH, Kaiser A, Riecken EO et al (2000) Molecular mechanism of interferon alfa-mediated growth inhibition in human neuroendocrine tumor cells. Gastroenterology 118(4):735–748
Frank M, Klose KJ, Wied M, Ishaque N, Schade-Brittinger C, Arnold R (1994) Combination therapy with octreotide and alpha inteferon: effect on tumour growth in metastatic endocrine gastroeheropancreatic tumours. Am J Gastroenterol 94(5):1381–1387
Oberg K, Funa K, Alm G (1983) Effects of leucocyte inteferon on clinical symptoms and hormone levels in patients with mud-gut carcinoid tumours and carcinoid syndrome. N Engl J Med 309(3):129–133
Rinke A, Müller HH, Schade-Brittinger C, Klose KJ, Barth P, Wied M et al (2009) Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors: a report from the PROMID Study Group. J Clin Oncol 27(28):4656–4563
Delavault P, Caplin ME, Liyange N (2012) The CLARINET study: assessing the effect of lanreotide autogel on tumor progression-free survival in patients with nonfunctioning gastroenteropancreatic neuroendocrine tumors. J Clin Oncol 30:abstr TPS4153
Murkherjee JJ, Kaltsas GA, Islam N, Plowman PN, Foley R, Hikmat J et al (2001) Treatment of metastatic carcinoid tumours, phaeochromocytoma, paraganglioma and medullary carcionam of the thyroid with (131)I-meta-iodobenzylguanidine [(131)ImIBG]. Clin Endocrinol 55:47–60
Safford SD, Coleman RE, Gockerman JP, Moore J, Feldman OMW et al (2004) Iodine-131 meta-iodobenzylguanidine treatment for metastatic carcinoid. Results in 98 patients. Cancer 101(9):1987–1993
Engstrom PF, Lavin PT, Moertel CG, Folsch E, Douglass HO (1984) Streptozocin plus flurouracil versus doxorubicin therapy for metastatic carcinoid tumour. J Clin Oncol 2(11):1255–1259
Moertel CG, Lefkopoulo M, Lipsitz S, Hahn RG, Klaassen D (1992) Streptozocin-doxorubicin, streptozocin-fluorouracil or chlorozotocin in the treatment of advanced islet-cell carcinoma. N Engl J Med 326(8):519–532
Kouvaraki MA, Ajani JA, Hoff P, Wolff R, Evans DB, Lozano R et al (2004) Fluorouracil, doxorubicin, and streptozocin in the treatment of patients with locally advanced and metastatic pancreatic endocrine carcinomas. J Clin Oncol 22(23):4762–4771
Medley L, Morel AN, Farrugia D, Reed N, Hayward N, Davies JM et al (2011) Phase II study of single agent capecitabine in the treatment of metastatic non-pancreatic neuroendocrine tumours. Br J Cancer 104(7):1067–1070
Ansell SM, Pitot HC, Burch PA, Kvolsk LK, Mahoney MR, Rubin J (2001) A phase II study of high-dose paclitaxel in patients with advanced neuroendocrine tumors. Cancer 91(8):1543–1548
Kulke MH, Kim H, Stuart K, Clark JW, Ryan DP, Vincitore M et al (2004) A phase II study of docetaxel in patients with metastatic carcinoid tumors. Cancer Investig 22(3):353–359
Kulke MH, Kim H, Clark JW, Enzinger PC, Lynch TJ, Morgan JA et al (2004) A phase II trial of gemcitabine for metastatic neuroendocrine tumors. Cancer 101(5):934–939
Ansell SM, Mahoney MR, Green EM, Rubin J (2004) Topotecan in patients with advanced neuroendocrine tumors: a phase II study with significant hematologic toxicity. Am J Clin Oncol 27(3):232–235
Kulke MH, Stuart K, Enzinger PC, Ryan DP, Clark JW, Muzikansky A et al (2006) Phase II study of temozolomide and thalidomide in patients with metastatic neuroendocrine tumors. J Clin Oncol 24(3):401–406
Chan JA, Stuart K, Earle CC, Clark JW, Bhargava P, Miksad R et al (2012) Prospective study of bevacizumab plus temozolomide in patients with advanced neuroendocrine tumors. J Clin Oncol 30(24):2963–2968
Strosberg JR, Fine RL, Choi J, Nasir A, Coppola D, Chen DT et al (2011) First-line chemotherapy with capecitabine and temozolomide in patients with metastatic pancreatic endocrine carcinomas. Cancer 117(2):268–275
Kulke MH, Hornick JL, Frauenhoffer C, Hooshmand S, Ryan DP, Enzinger PC et al (2009) O6-Methylguanine DNA Methyltransferase deficiency and response to Temozolomide-based therapy in patients with Neuroendocrine Tumors. Clin Cancer Res 15(1):338–345
Fjällskog ML, Granberg DP, Welin SL, Eriksson C, Oberg KE, Janson ET et al (2001) Treatment with cisplatin and etoposide in patients with neuroendocrine tumors. Cancer 92(5):1101–1107
Sorbye H, Welin S, Langer SW, Vestermark LW, Holt N, Osterlund P et al (2013) Predictive and prognostic factors for treatment and survival in 305 patients with advanced gastrointestinal neuroendocrine carcinoma (WHO G3): the NORDIC NEC study. Ann Oncol 24(1):152–162
Kulke MH, Lenz HJ, Meropol NJ, Posey J, Ryan DP, Picus J, Bergsland E, Stuart K, Tye L, Huang X (2008) Activity of sunitinib in patients with advanced neuroendocrine tumors. J Clin Oncol 26:3403–3410
Raymond E, Dahan RJL, Bang YJ, Borbath I, Lombard-Bohas C et al (2011) Sunitinib Malate for the treatment of pancreatic neuroendocrine tumors. NEJM 364:501–513
Yao JC, Phan AT, Chang DZ, Wolff RA, Hess K, Gupta S et al (2008) Efficacy of RAD001 (everolimus) and octreotide LAR in advanced low- to intermediate-grade neuroendocrine tumors: results of a phase II study. J Clin Oncol 26:4311–4318
Yao JC, Lombard-Bohas C, Baudin E, Kvols LK, Rougier P, Ruszniewski P et al (2010) Daily oral everolimus activity in patients with metastatic pancreatic neuroendocrine tumors after failure of cytotoxic chemotherapy: a phase II trial. J Clin Oncol 28:69–76
Yao JC, Shah MH, Ito T, Bohas CL, Wolin EM, Van Cutsem E et al (2011) Everolimus for advanced pancreatic neuroendocrine tumors. NEJM 354:514–523
Shah MH, Ito T, Lombard-Bohas C, Wolin EM, Van Cutsem E, Sachs C et al (2011) Everolimus in patients with advanced pancreatic neuroendocrine tumors (pNET): updated results of a randomized, double-blind, placebo-controlled, multicenter phase III trial (RADIANT-3). J Clin Oncol 29:158
Yao JC, Hainsworth JD, Baudin E, Peeters M, Hoersch D, Anthony LB et al (2011) Everolimus plus octreotide LAR (E+O) versus placebo plus octreotide LAR (P+O) in patients with advanced neuroendocrine tumors (NET): Updated results of a randomized, double-blind, placebo-controlled, multicenter phase III trial (RADIANT-2). J Clin Oncol 29:159
Yao JC, Phan A, Hoff PM, Chen HX, Charnsangavej C, Yeung SC et al (2008) Targeting vascular endothelial growth factor in advanced carcinoid tumor: a random assignment phase II study of depot octreotide with bevacizumab and pegylated interferon alpha-2b. J Clin Oncol 26:1316–1323
Yao JC, Phan AT, Fogleman D, Ng CS, Jacobs CB, Dagohoy CD et al (2010) Randomized run-in study of bevacizumab (B) and everolimus (E) in low- to intermediate-grade neuroendocrine tumors (LGNETs) using perfusion CT as functional biomarker. J Clin Oncol 28:4002
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Yim, K.L., Thomas, B.M., Christian, A. (2019). Clinical Approaches to the Management of Neuroendocrine Tumours. In: De Mello, R., Mountzios, G., Tavares, Á. (eds) International Manual of Oncology Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-16245-0_38
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