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Tsang ES, Loree JM, Speers C, Kennecke HF. Sequence of therapy and survival in patients with advanced pancreatic neuroendocrine tumours. Curr Oncol 2020; 27:215-219. [PMID: 32905342 PMCID: PMC7467789 DOI: 10.3747/co.27.5929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Pancreatic neuroendocrine tumours (pnets) often present as advanced disease. The optimal sequence of therapy is unknown. Methods Sequential patients with advanced pnets referred to BC Cancer between 2000 and 2013 who received 1 or more treatment modalities were reviewed, and treatment patterns, progression-free survival (pfs), and overall survival (os) were characterized. Systemic treatments included chemotherapy, small-molecule therapy, and peptide receptor radionuclide therapy. Results In 66 cases of advanced pnets, median patient age was 61.2 years (25%-75% interquartile range: 50.8-66.2 years), and men constituted 47% of the group. First-line therapies were surgery (36%), chemotherapy (33%), and somatostatin analogues (32%). Compared with first-line systemic therapy, surgery in the first line was associated with increased pfs and os (20.6 months vs. 6.3 months and 100.3 months vs. 30.5 months respectively, p < 0.05). In 42 patients (64%) who received more than 1 line of therapy, no difference in os or pfs between second-line therapies was observed. Conclusions Our results confirm the primary role of surgery for advanced pnets. New systemic treatments will further increase options.
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Affiliation(s)
- E S Tsang
- Division of Medical Oncology, BC Cancer
- Department of Medicine, University of British Columbia
| | - J M Loree
- Division of Medical Oncology, BC Cancer
| | - C Speers
- Gastrointestinal Cancers Outcomes Unit, BC Cancer, Vancouver, BC
| | - H F Kennecke
- Division of Medical Oncology, BC Cancer
- Department of Oncology, Virginia Mason Cancer Institute, Seattle, WA, U.S.A
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Xu Q, Chen B, Jin D, Yin L, Huang Y. An assessment for health education and health promotion in chronic disease demonstration districts: a comparative study from Hunan Province, China. PeerJ 2019; 7:e6579. [PMID: 30867995 PMCID: PMC6409084 DOI: 10.7717/peerj.6579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/06/2019] [Indexed: 11/20/2022] Open
Abstract
Background Cost-effective strategies of chronic disease control, integrated health education and health promotion play important roles in the programs of chronic disease demonstration districts in China. The performance of these districts can be directly assessed by their health education and promotion work. However, there have been only a few performance assessments done on these programs, most of which made without the inclusion of proper quality indicators. This study was designed to establish a framework of indicators for outcome evaluation of health education and promotion efforts in Chinese districts, and explore the factors involved in promoting these efforts. Methods A modified two-round Delphi survey was first used to construct quality indicators on a nine-point Likert scale. With those indicators, the rank sum ratio (RSR) method was then conducted through rank conversion and parametric statistics, to assess and classify the performance of ten districts or counties randomly chosen both from demonstration and non-demonstration districts in the Hunan province. Results The Delphi process produced seven themes and 25 sub-themes as quality indicators. The seven themes included organizational management, financial support, professional personnel, health education and promotion, residents' health awareness and behaviors, residents' satisfaction, and residents' health literacy. The districts were classified into four levels by RSR as follows: One demonstration district at the first-ranked level, five other demonstration districts at the second-ranked level, all non-demonstration districts at the third-ranked level. None were at the fourth-qualified level. Discussion Chronic disease demonstration districts performed better on the work of health education and health promotion than the non-demonstration districts. The work should be focused on the following measures of chronic diseases: organizational management, financial support, media-related broadcasting, technical support, community-based promotion and supportive environment, and people's enhanced awareness and health literacy.
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Affiliation(s)
- Qiaohua Xu
- Department of Chronic Diseases Control and Prevention, Hunan Provincial Center for Diseases Control and Prevention, Changsha, Hunan, China
| | - Biyun Chen
- Department of Chronic Diseases Control and Prevention, Hunan Provincial Center for Diseases Control and Prevention, Changsha, Hunan, China
| | - Donghui Jin
- Department of Chronic Diseases Control and Prevention, Hunan Provincial Center for Diseases Control and Prevention, Changsha, Hunan, China
| | - Li Yin
- Department of Chronic Diseases Control and Prevention, Hunan Provincial Center for Diseases Control and Prevention, Changsha, Hunan, China
| | - Yuelong Huang
- Department of Chronic Diseases Control and Prevention, Hunan Provincial Center for Diseases Control and Prevention, Changsha, Hunan, China
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Surgery Provides Long-Term Survival in Patients with Metastatic Neuroendocrine Tumors Undergoing Resection for Non-Hormonal Symptoms. J Gastrointest Surg 2019; 23:122-134. [PMID: 30334178 PMCID: PMC10183101 DOI: 10.1007/s11605-018-3986-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 09/20/2018] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Patients with metastatic neuroendocrine tumor (NET) often have an indolent disease course yet the outcomes for patients with metastatic NET undergoing surgery for non-hormonal (NH) symptoms of GI obstruction, bleeding, or pain is not known. METHODS We identified patients with metastatic gastroenteropancreatic NET who underwent resection from 2000 to 2016 at 8 academic institutions who participated in the US Neuroendocrine Tumor Study Group. RESULTS Of 581 patients with metastatic NET to liver (61.3%), lymph nodes (24.1%), lung (2.1%), and bone (2.5%), 332 (57.1%) presented with NH symptoms of pain (n = 223, 67.4%), GI bleeding (n = 54, 16.3%), GI obstruction (n = 49, 14.8%), and biliary obstruction (n = 22, 6.7%). Most patients were undergoing their first operation (85.4%) within 4 weeks of diagnosis. The median overall survival was 110.4 months, and operative intent predicted survival (p < 0.001) with 66.3% undergoing curative resection. Removal of all metastatic disease was associated with the longest median survival (112.5 months) compared to debulking (89.2 months), or palliative resection (50.0 months; p < 0.001). The 1-, 3-, and 12-month mortality was 3.0%, 4.5%, and 9.0%, respectively. Factors associated with 1-year mortality included palliative operations (OR 6.54, p = 0.006), foregut NET (5.62, p = 0.042), major complication (4.91, p = 0.001), and high tumor grade (11.2, p < 0.001). The conditional survival for patients who lived past 1 year was 119 months. CONCLUSIONS Patients with metastatic NET and NH symptoms that necessitate surgery have long-term survival, and goals of care should focus on both oncologic and quality of life impact. Surgical intervention remains a critical component of multidisciplinary care of symptomatic patients.
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Geer EB, Ayala A, Bonert V, Carmichael JD, Gordon MB, Katznelson L, Manuylova E, Shafiq I, Surampudi V, Swerdloff RS, Broder MS, Cherepanov D, Eagan M, Lee J, Said Q, Neary MP, Biller BMK. Follow-up intervals in patients with Cushing's disease: recommendations from a panel of experienced pituitary clinicians. Pituitary 2017; 20:422-429. [PMID: 28275992 DOI: 10.1007/s11102-017-0801-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Follow-up guidelines are needed to assess quality of care and to ensure best long-term outcomes for patients with Cushing's disease (CD). The purpose of this study was to assess agreement by experts on recommended follow-up intervals for CD patients at different phases in their treatment course. METHODS The RAND/UCLA modified Delphi process was used to assess expert consensus. Eleven clinicians who regularly manage CD patients rated 79 hypothetical patient scenarios before and after ("second round") an in-person panel discussion to clarify definitions. Scenarios described CD patients at various time points after treatment. For each scenario, panelists recommended follow-up intervals in weeks. Panel consensus was assigned as follows: "agreement" if no more than two responses were outside a 2 week window around the median response; "disagreement" if more than two responses were outside a 2 week window around the median response. Recommendations were developed based on second round results. RESULTS Panel agreement was 65.9% before and 88.6% after the in-person discussion. The panel recommended follow-up within 8 weeks for patients in remission on glucocorticoid replacement and within 1 year of surgery; within 4 weeks for patients with uncontrolled persistent or recurrent disease; within 8-24 weeks in post-radiotherapy patients controlled on medical therapy; and within 24 weeks in asymptomatic patients with stable plasma ACTH concentrations after bilateral adrenalectomy. CONCLUSIONS With a high level of consensus using the Delphi process, panelists recommended regular follow-up in most patient scenarios for this chronic condition. These recommendations may be useful for assessment of CD care both in research and clinical practice.
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Affiliation(s)
- Eliza B Geer
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA.
| | - Alejandro Ayala
- University of Miami and Jackson Memorial Hospital, 1500 NW 10th Avenue, Miami, FL, USA
| | - Vivien Bonert
- Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, USA
| | - John D Carmichael
- Keck School of Medicine of University of Southern California, 1520 San Pablo Street, Los Angeles, CA, USA
| | - Murray B Gordon
- Allegheny Neuroendocrinology Center, Allegheny General Hospital, 420 East North Avenue, Pittsburgh, PA, USA
| | - Laurence Katznelson
- Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA, USA
| | - Ekaterina Manuylova
- University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY, USA
| | - Ismat Shafiq
- University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY, USA
| | - Vijaya Surampudi
- Harbor-UCLA Medical Center, 1124 W. Carson St., Torrance, CA, USA
| | | | - Michael S Broder
- Partnership for Health Analytic Research, LLC, 280 S. Beverly Drive, Beverly Hills, CA, USA
| | - Dasha Cherepanov
- Partnership for Health Analytic Research, LLC, 280 S. Beverly Drive, Beverly Hills, CA, USA
| | - Marianne Eagan
- Partnership for Health Analytic Research, LLC, 280 S. Beverly Drive, Beverly Hills, CA, USA
| | - Jackie Lee
- Partnership for Health Analytic Research, LLC, 280 S. Beverly Drive, Beverly Hills, CA, USA
| | - Qayyim Said
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, USA
| | - Maureen P Neary
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, USA
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Merola E, Panzuto F, Fave GD. Antiproliferative effect of somatostatin analogs in advanced gastro-entero-pancreatic neuroendocrine tumors: a systematic review and meta-analysis. Oncotarget 2017; 8:46624-46634. [PMID: 28402955 PMCID: PMC5542298 DOI: 10.18632/oncotarget.16686] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/17/2017] [Indexed: 01/12/2023] Open
Abstract
A meta-analysis has systematically investigated the antineoplastic efficacy and safety of somatostatin analogs (SSAs) in advanced gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs). Randomized controlled trials (RCTs) reporting the hazard ratio (HR) for disease progression (DP) were evaluated. Response rate and risk ratio (RR) for adverse events were also analyzed. A total of 289 patients (143 receiving SSAs vs. 146 placebo) were evaluated from two RCTs. A significant benefit from SSAs in terms of disease control was observed (HR 0.41, 95% CI: 0.29 to 0.58, P < 0.01; I20%), response rate being 58.0% vs. 32.2%, respectively.The occurrence of adverse events significantly differed from the placebo arm only in terms of biliary stones (RR 3.79, 95% CI: 1.28 to 11.17, P = 0.02; I20%). In conclusion, SSAs showed an antiproliferative effect in advanced GEP-NETs, with a good safety profile.
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Affiliation(s)
- Elettra Merola
- Department of Digestive and Liver Diseases, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Francesco Panzuto
- Department of Digestive and Liver Diseases, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Gianfranco Delle Fave
- Department of Digestive and Liver Diseases, Sapienza University, Sant'Andrea Hospital, Rome, Italy
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6
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Affiliation(s)
- Elettra Merola
- Department of Digestive and Liver Diseases, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Francesco Panzuto
- Department of Digestive and Liver Diseases, Sapienza University, Sant'Andrea Hospital, Rome, Italy
| | - Gianfranco Delle Fave
- Department of Digestive and Liver Diseases, Sapienza University, Sant'Andrea Hospital, Rome, Italy
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Gallo M, Malandrino P, Fanciulli G, Rota F, Faggiano A, Colao A. Everolimus as first line therapy for pancreatic neuroendocrine tumours: current knowledge and future perspectives. J Cancer Res Clin Oncol 2017; 143:1209-1224. [PMID: 28405826 DOI: 10.1007/s00432-017-2407-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 03/24/2017] [Indexed: 01/21/2023]
Abstract
PURPOSE Everolimus has been shown to be effective for advanced pancreatic neuroendocrine tumours (pNETs), but its positioning in the therapeutic algorithm for pNETs is matter of debate. METHODS With the aim to shed light on this point, we performed an up-to-date critical review taking into account the results of both retrospective and prospective published studies, and the recommendations of international guidelines. In addition, we performed an extensive search on the Clinical Trial Registries databases worldwide, to gather information on the ongoing clinical trials related to this specific topic. RESULTS We identified eight retrospective published studies, two prospective published studies, and five registered clinical trials. Moreover, we analyzed the content of four widespread international guidelines. CONCLUSIONS Our critical review confirms the lack of high-quality data to recommend everolimus as the first line therapy for pNETs. The ongoing clinical trials reported in this review will hopefully help clinicians, in the near future, to better evaluate the role of everolimus as the first line therapy for pNETs. However, at the moment, there is already enough evidence to recommend everolimus as the first line therapy for patients with symptomatic malignant unresectable insulin-secreting pNETs, to control the endocrine syndrome regardless of tumour growth.
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Affiliation(s)
- Marco Gallo
- Oncological Endocrinology Unit, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Turin, Italy.
| | | | - Giuseppe Fanciulli
- Neuroendocrine Tumours Unit, Department of Clinical and Experimental Medicine, University of Sassari, AOU Sassari, Sassari, Italy
| | - Francesca Rota
- Endocrinology Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Antongiulio Faggiano
- Thyroid and Parathyroid Surgery Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione G. Pascale", IRCCS, Naples, Italy
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery, University "Federico II", Naples, Italy
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Management Options for Advanced Low or Intermediate Grade Gastroenteropancreatic Neuroendocrine Tumors: Review of Recent Literature. Int J Surg Oncol 2017; 2017:6424812. [PMID: 28593056 PMCID: PMC5448049 DOI: 10.1155/2017/6424812] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/13/2017] [Accepted: 04/26/2017] [Indexed: 02/06/2023] Open
Abstract
Our understanding of the biology, genetics, and natural history of neuroendocrine tumors (NETs) of the gastrointestinal tract and pancreas has improved considerably in the last several decades and the spectrum of available therapeutic options is rapidly expanding. The management of patients with metastatic low or intermediate grade NETs has been revolutionized by the development of new treatment strategies such as molecular targeting therapies with everolimus and sunitinib, somatostatin analogs, tryptophan hydroxylase inhibitors, and peptide receptor radionuclide therapy that can be used alone or as a multimodal approach with or without surgery. To further define and clarify the utility, appropriateness, and the sequence of the growing list of available therapies for this patient population will require more high level evidence; however, data from well-designed randomized phase III clinical trials is rapidly accumulating that will further stimulate development of new management strategies. It is therefore important to thoroughly review emerging evidence and report major findings in frequent updates, which will expand our knowledge and contribute to a better understanding, characterization, and management of advanced NETs.
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Aprile G, Rihawi K, De Carlo E, Sonis ST. Treatment-related gastrointestinal toxicities and advanced colorectal or pancreatic cancer: A critical update. World J Gastroenterol 2015; 21:11793-11803. [PMID: 26557003 PMCID: PMC4631977 DOI: 10.3748/wjg.v21.i41.11793] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/06/2015] [Accepted: 09/15/2015] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal toxicities (GIT), including oral mucositis, nausea and vomiting, and diarrhea, are common side effects of chemotherapy and targeted agents in patients with advanced colorectal cancer and pancreatic cancer. Being often underreported, it is still difficult to precisely establish their burden in terms of both patient’s quality of life and cancer care costs. Moreover, with the use of more intensive upfront combination regimens, the frequency of these toxicities is rapidly growing with a potential negative effect also on patient’s outcome, as a result of dose reductions, delays or even discontinuation of active treatments. Thus, identifying patients at higher risk of developing GIT as well as an optimal management are paramount in order to improve patient’s compliance and outcome. After the description of the main treatment-induced GIT, we discuss the current knowledge on the pathophysiology of these side effects and comment the scales commonly used to assess and grade them. We then provide a critical update on GIT incidence based on the results of key randomized trials conducted in patients with metastatic colorectal cancer and advanced pancreatic cancer.
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Chiang PJ, Li TC, Chang CH, Chen LL, Lin JD, Su YC. SEED: the six excesses (Liu Yin) evaluation and diagnosis scale. Chin Med 2015; 10:30. [PMID: 26516343 PMCID: PMC4624590 DOI: 10.1186/s13020-015-0059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 09/14/2015] [Indexed: 11/27/2022] Open
Abstract
Background Infections such as common colds, influenza, acute upper respiratory infections, bacterial gastroenteritis, and urinary tract infections are usually diagnosed according to patients’ signs and symptoms. This study aims to develop a scale for the diagnosis of infectious diseases based on the six excesses (Liu Yin) etiological theory of Chinese medicine (CM) by the Delphi method. Methods A total of 200 CM-guided diagnostic items measuring signs and symptoms for infectious diseases were compiled from CM literature archives from the Han to Ming dynasties, CM textbooks in both China and Taiwan, and journal articles from the China Knowledge Resource Integrated Database. The items were based on infections and the six excesses (Liu Yin) etiological theory, i.e., Feng Xie (wind excess), Han Xie (coldness excess), Shu Xie (summer heat excess), Shi Xie (dampness excess), Zao Xie (dryness excess), and Huo Xie (fire excess). The items were further classified into the six excess syndromes and reviewed via a Delphi process to reach consensus among CM experts. Results In total, 178 items with a mean or median rating of 7 or above on a scale of 1–9 from a panel of 32 experts were retained. The numbers of diagnostic items in the categories of Feng (wind), Han (coldness), Shu (summer heat), Shi (dampness), Zao (dryness), and Huo (fire) syndromes were 15, 22, 25, 37, 17, and 62, respectively. Conclusions A CM-based six excesses (Liu Yin) evaluation and diagnosis (SEED) scale was developed for the evaluation and diagnosis of infectious diseases based only on signs and symptoms.
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Affiliation(s)
- Pei-Jung Chiang
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, China Medical University, Taichung, Taiwan ; Department of Traditional Chinese Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, China Medical University, Taichung, Taiwan
| | - Chih-Hung Chang
- Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Li-Li Chen
- School of Nursing, China Medical University, Taichung, Taiwan ; Department of Nursing, China Medical University Hospital, Taichung, Taiwan
| | - Jun-Dai Lin
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Yi-Chang Su
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, China Medical University, Taichung, Taiwan
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Wang G, Ma Y, Qu FZ, Sun B. Status quo of diagnosis and treatment of pancreatic neuroendocrine tumors. Shijie Huaren Xiaohua Zazhi 2015; 23:3817-3823. [DOI: 10.11569/wcjd.v23.i24.3817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Pancreatic neuroendocrine tumors (PNETs) are clinically rare digestive system tumors, which are characterized by insidious onset, a high potential of malignant tendency and a high misdiagnosis rate. In recent years, with the gradual increase of incidence and the continuous improvement of clinical diagnosis level, the detection and diagnosis rates of PNETs have been constantly increasing. In view of their malignant potential, early diagnosis and surgical intervention are essential. Therefore, clinicians should raise their awareness of this disease so as to effectively improve the diagnosis and treatment.
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Alonso-Gordoa T, Díez JJ, Molina J, Reguera P, Martínez-Sáez O, Grande E. An Overview on the Sequential Treatment of Pancreatic Neuroendocrine Tumors (pNETs). ACTA ACUST UNITED AC 2015; 3:13-33. [PMID: 27182476 PMCID: PMC4837935 DOI: 10.1007/s40487-015-0007-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Indexed: 01/10/2023]
Abstract
Patients suffering from pancreatic neuroendocrine tumors (pNETs) are now candidates to receive novel approved drugs that have demonstrated benefit in disease control rate and delay the time taken for tumor progression in Phase III clinical trials; for example, sunitinib, everolimus and lanreotide. Though pNETs represent a rare and heterogeneous disease, recent approaches are being taken to better understand the molecular pathways involved in carcinogenesis. Consequently, new treatment strategies are now available and others still under investigation show promising results. However, some questions around how to approach patients with pNETs are still unresolved, such as what the best sequence of treatments we can offer to each of our patients in the clinic at any time of their disease would be. Therapeutic decisions are, at the moment, guided by clinical judgment, based on different parameters coming from retrospective analysis and non-randomized clinical trials. However, advances in genomic research would lead to a more precise approach using therapeutic targets that would also allow the development of new agents, prognostic or predictive biomarkers and a better understanding of resistance mechanisms. The following article is a comprehensive review of the approved and investigational drugs in pNET, and highlights the current concerns about treatment sequencing, but also provides an update of some of the present and future efforts for an improvement in the therapeutic algorithm of the disease.
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Affiliation(s)
- Teresa Alonso-Gordoa
- Medical Oncology Department, Ramón y Cajal University Hospital, Ctra. Colmenar Viejo km 9100, 28034 Madrid, Spain
| | - Juan José Díez
- Endocrinology and Nutrition Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Javier Molina
- Medical Oncology Department, Ramón y Cajal University Hospital, Ctra. Colmenar Viejo km 9100, 28034 Madrid, Spain
| | - Pablo Reguera
- Medical Oncology Department, Ramón y Cajal University Hospital, Ctra. Colmenar Viejo km 9100, 28034 Madrid, Spain
| | - Olga Martínez-Sáez
- Medical Oncology Department, Ramón y Cajal University Hospital, Ctra. Colmenar Viejo km 9100, 28034 Madrid, Spain
| | - Enrique Grande
- Medical Oncology Department, Ramón y Cajal University Hospital, Ctra. Colmenar Viejo km 9100, 28034 Madrid, Spain
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