Considerations concerning a tailored, individualized therapeutic management of patients with (neuro)endocrine tumours of the gastrointestinal tract and pancreas.

Herder, Wouter W. de; Krenning, Eric P.; Eijck, Casper H.J. van; Lamberts, S. W. J.

doi:10.1677/erc.0.0110019

Cited by 37 publications

(17 citation statements)

References 140 publications

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“…Thus, PD with lymph node dissection should be considered as the procedure of choice for patients with gastrinoma. However, considering the malignancy pattern of this tumor – confirmed by the high prevalence of metastatic spread at diagnosis – other complementary treatments, such as SSA and/or peptide receptor therapies, should be considered in order to achieve hormonal and disease control [31]. …”

Section: Discussionmentioning

confidence: 99%

Presentation and Outcome of Pancreaticoduodenal Endocrine Tumors in Multiple Endocrine Neoplasia Type 1 Syndrome

Davì¹,

Boninsegna²,

Carbonare³

et al. 2011

Neuroendocrinology

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Aim: To assess presentation and outcome of pancreaticoduodenal endocrine tumors (PDETs) in a single center series of multiple endocrine neoplasia type 1 (MEN1) patients. Methods: Retrospective analysis of prospectively collected data of MEN1 patients observed at the University of Verona. Results: Thirty-one MEN1 patients had PDETs, including 16 nonfunctioning (NF), 6 insulinomas and 9 Zollinger-Ellison syndrome (ZES). In 16 of these patients (52%), PDET was the manifestation which led to the diagnosis of MEN1; among this group, 15 patients (94%) previously had unidentified primary hyperparathyroidism (PHPT), which was asymptomatic in 9 cases (60%). Of the 31 patients, 19 (61%) underwent curativesurgery and 13 (68%, 7 NF-PDETs, 4 insulinomas and 2 ZES) were disease-free after a median follow-up of 3 years (range: 0.5–15). One patient had debulking surgery with stable disease after 2 years of follow-up. Eight patients with NF-PDETs ≤20 mm and 2 with ZES, treated with a conservative approach, showed stable disease. One patient with insulinoma was lost to follow-up. Conclusions: PDET may be the manifestation that leads to MEN1 diagnosis since the almost constant presence of PHPT is very often unrecognized or considered sporadic. Conversely, the presence of PDETs should be looked for in all patients presenting PHPT, even if asymptomatic, particularly before age 50. Surgery may be curative in the majority of insulinomas and can prolong disease-free survival in NF-PDET, but is not proven to be effective in ZES. A conservative approach can be safely reserved for patients with NF-PDETs ≤20 mm.

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Section: Discussionmentioning

confidence: 99%

Presentation and Outcome of Pancreaticoduodenal Endocrine Tumors in Multiple Endocrine Neoplasia Type 1 Syndrome

Davì¹,

Boninsegna²,

Carbonare³

et al. 2011

Neuroendocrinology

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“…In these cases, there are relatively few therapeutic options and most of them are palliative. Surgery is indicated only for conservative resections of the intestine, mesenteric tumors, and fibrotic areas to improve symptoms and quality of life (6). Hepatic resection in selected patients with metastatic functioning GEPNETs is safe, provides temporary relief of symptoms, and may prolong survival (6,7).…”

Section: Introductionmentioning

confidence: 99%

“…Surgery is indicated only for conservative resections of the intestine, mesenteric tumors, and fibrotic areas to improve symptoms and quality of life (6). Hepatic resection in selected patients with metastatic functioning GEPNETs is safe, provides temporary relief of symptoms, and may prolong survival (6,7). As alternative to hepatic resection in patients with liver metastases, local ablative procedures may also be considered, including chemoembolization, laser, and radiofrequency ablation, as palliative support to control symptoms of hypersecretion syndrome (6).…”

Section: Introductionmentioning

confidence: 99%

“…Hepatic resection in selected patients with metastatic functioning GEPNETs is safe, provides temporary relief of symptoms, and may prolong survival (6,7). As alternative to hepatic resection in patients with liver metastases, local ablative procedures may also be considered, including chemoembolization, laser, and radiofrequency ablation, as palliative support to control symptoms of hypersecretion syndrome (6). The use of chemotherapeutic regimens is limited to fast growing or undifferentiated tumors (8).…”

Section: Introductionmentioning

confidence: 99%

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IFN-β Is a Highly Potent Inhibitor of Gastroenteropancreatic Neuroendocrine Tumor Cell Growth In vitro

et al. 2006

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IFN-A controls hormone secretion and symptoms in human gastroenteropancreatic neuroendocrine tumors (GEP-NET) but it rarely induces a measurable tumor size reduction. The effect of other type I IFNs, e.g., IFN-B, has not been evaluated. We compared the antitumor effects of IFN-A and IFN-B in BON cells, a functioning human GEP-NET cell line. As determined by quantitative reverse transcription-PCR analysis and immunocytochemistry, BON cells expressed the active type I IFN receptor mRNA and protein (IFNAR-1 and IFNAR-2c subunits). After 3 and 6 days of treatment, IFN-B significantly inhibited BON cell growth in a time-and dose-dependent manner. IC 50 and maximal inhibitory effect on day 6 were 8 IU/mL and 98%, respectively. In contrast, the effect of IFN-A resulted significantly in a less potent effect (IC 50 : 44 IU/mL, maximal inhibition: 26%). IFN-A induced only cell cycle arrest, with an accumulation of the cells in S phase. IFN-B, apart from a more potent delay in S-G 2 -M phase transit of the cell cycle, also induced a strong stimulation of apoptosis, evaluated by flow cytometry (Annexin V and 7-AAD) and measurement of the DNA fragmentation. Besides, only IFN-B severely suppressed chromogranin A levels in the medium from BON cells after 6 days of treatment. In conclusion, IFN-B is much more potent, compared with IFN-A, in its inhibitory effect on GEP-NET cell proliferation in vitro through the induction of apoptosis and cell cycle arrest. Further studies are required to establish whether IFN-B has comparable potent tumor growth inhibitory effects in vivo. (Cancer Res 2006; 66(1): 554-62)

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“…Dementsprechend ist die hoch dosierte Therapie mit Protonenpumpeninhibitoren mitentscheidend für die Prognose. Octreotid ist weniger effektiv und Mittel der zweiten Wahl [13,59,60].…”

Section: Besonderheiten In Der Therapie Einzelner Entitätenunclassified

Nichtoperative Therapiemöglichkeiten gastroenteropankreatischer neuroendokriner Tumoren

Busse¹,

Mössner²,

Stümvoll³

et al. 2007

Visc Med

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Gastroenteropancreatic neuroendocrine tumors (NET) are an extremely heterogeneous entity with respect to their biological behavior and functionality. Considering the diversity of NET, therapeutic approaches should be chosen carefully. Besides surgical resection or tumor debulking, various palliative options including medical, locally ablative and radiotherapeutical interventions are available. In functionally active tumors biotherapy with either somatostatin analogues or interferon alpha is indicated. The results of chemotherapy are often unsatisfactory, and its use is mostly restricted to pancreatic neuroendocrine carcinomas. Here, streptozotocin and 5-fluorouracil or doxorubicin are considered standard first-line therapy. In slowly progressing disease, however, chemotherapy is not effective. In rapidly growing carcinomas etoposide and cisplatin are mostly applied. In the treatment of hepatic metastases, embolization therapy with or without chemotherapy is frequently used when surgery is not an option. Radiofrequency ablation is another alternative. In tumors with strong somatostatin receptor expression, radionuclide therapy is an approach that enables internal radiation therapy. Bearing in mind actually running active clinical trials, we here present a therapeutic algorithm which we hope will facilitate therapeutical decision making.

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Considerations concerning a tailored, individualized therapeutic management of patients with (neuro)endocrine tumours of the gastrointestinal tract and pancreas.

Cited by 37 publications

References 140 publications

Presentation and Outcome of Pancreaticoduodenal Endocrine Tumors in Multiple Endocrine Neoplasia Type 1 Syndrome

Presentation and Outcome of Pancreaticoduodenal Endocrine Tumors in Multiple Endocrine Neoplasia Type 1 Syndrome

IFN-β Is a Highly Potent Inhibitor of Gastroenteropancreatic Neuroendocrine Tumor Cell Growth In vitro

Nichtoperative Therapiemöglichkeiten gastroenteropankreatischer neuroendokriner Tumoren

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