The role of multimodal treatment in patients with advanced lung neuroendocrine tumors

Abstract

Lung neuroendocrine tumors (NETs) comprise typical (TC) and atypical carcinoids (AC). They represent the well differentiated (WD) or low/intermediate grade forms of lung neuroendocrine neoplasms (NENs). Unlike the lung poorly differentiated NENs, that are usually treated with chemotherapy, lung NETs can be managed with several different therapies, making a multidisciplinary interaction a key point. We critically discussed the multimodal clinical management of patients with advanced lung NETs. Provided that no therapeutic algorithm has been validate so far, each clinical case should be discussed within a NEN-dedicated multidisciplinary team. Among the systemic therapies available for metastatic lung NETs everolimus is the only approved drug, on the basis of the results of the phase III RADIANT-4 trial. Another phase III trial, the SPINET, is ongoing comparing lanreotide with placebo. Peptide receptor radionuclide therapy and chemotherapy were not studied within phase III trials for lung NETs, and they have been reported to be active within retrospective or phase II prospective studies. Temozolomide and oxaliplatin are two interesting chemotherapeutic agents in lung NETs. While some European Institutions were certificated as Centers of Excellence for gastroenteropancreatic NENs by the European Neuroendocrine Tumor Society (ENETS), an equivalent ENETS certification for lung NENs does not exist yet. Ideally a lung NEN-dedicated multidisciplinary tumor board should include NEN-dedicated medical oncologists, thoracic medical oncologist, thoracic surgeons, pathologists, interventional radiologists, endocrinologists, radiotherapists, interventional pneumologists, nuclear physician.

A single-institution retrospective analysis of metachronous and synchronous metastatic bronchial neuroendocrine tumors

“…Studies of therapies in the advanced or metastatic lung carcinoid setting have been limited to retrospective analyses and some small prospective studies (6,(38)(39)(40). Recent articles reviewed the current standard of care and recent advances in therapy for bpNETs (41)(42)(43)(44).…”

Diagnostic and Management Pathways for Pulmonary Carcinoid Tumours in the United Kingdom: Results from the National Lung Neuroendocrine Tumour Pathway Project

“…Our results have shown that whilst all CoE and most non-CoE employ multidisciplinary teams for treating patients with AC/TC tumours, less than half (41%) of the non-CoE reported having a NET CNS on-site. Greater access to NET CNS and NET-specialist MDT meetings in CoE may result in improved supportive care for patients [35,36]. Furthermore, though based on small numbers, our results suggest that CoE are more likely to use a wider range of diagnostic approaches compared to non-CoE, including greater use of ENETS-recommended tests and assessments such as gallium PET [8].…”

Opening New Horizons in the Treatment of Childhood Onset Leukodystrophies

“…Long-standing comparable and partially successful concepts are already established in cancer therapies. 75,76 Fig . 1 Treatment approaches for leukodystrophies.…”