NEUROENDOCRINE TUMORS
Guest Editors: Bombardieri E. 

The Quarterly Journal of Nuclear Medicine 2000 March;44(1):96-101

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

New clinical trials for the treatment of neuroendocrine tumors

Bajetta E., Bichisao E., Artale S., Celio L., Ferrari L., Di Bartolomeo M., Zilembo N., Stani S. C., Buzzoni R.

From the Unit of Oncology B *Medical Office, Italian Trials in Medical Oncology (ITMO) Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy

In oncol­o­gy ­there is an increas­ing inter­est in neu­ro­en­do­crine ­tumors, ­whose inci­dence is gen­er­al­ly con­sid­ered low, ­although in a ­recent anal­y­sis of 5,468 cas­es ­there was an ­increase in the pro­por­tion of pul­mo­nary and gas­tric car­ci­noids and a ­decrease in the appen­di­ceal car­ci­noids. However car­ci­noid ­tumors are indo­lent and ­their diag­no­sis is ­often dif­fi­cult to car­ry out, so the ­true inci­dence may be high­er. Surgery ­remains the treat­ment of ­choice and it ­should ­always be con­sid­ered in ­patients ­with neu­ro­en­do­crine ­tumors ­although a com­plete ­cure is dif­fi­cult to ­obtain. Cytotoxic chem­o­ther­a­py is the med­i­cal treat­ment for high­ly pro­life­rat­ing neu­ro­en­do­crine ­tumors, but it has ­showed a mod­est ben­e­fit. Somatostatin ana­logues, octre­o­tide and lan­re­o­tide are the stan­dard hor­mo­nal treat­ment for neu­ro­en­do­crine ­tumors. Recently, two ­trials on lan­re­o­tide and octre­o­tide ­have ­been pub­lished, and it is ­worth not­ing ­that in ­each ­trial a ­long-act­ing for­mu­la­tion has ­been ­used: for lan­re­o­tide a pro­longed-­release for­mu­la­tion (PR) ­which ­allows an injec­tion of 30 mg eve­ry 2 ­weeks, and for octre­o­tide a ­long-act­ing ­release for­mu­la­tion (LAR) ­which ­allows an injec­tion of 10, 20 or 30 mg eve­ry 28 ­days. The ­results of ­each ­trial are ­very prom­is­ing.
However, ­there are method­o­log­i­cal and clin­i­cal ­aspects ­which ­make it dif­fi­cult to car­ry out new ­trials for stud­y­ing neu­ro­en­do­crine ­tumors. The increas­ing num­ber of bio­log­i­cal mark­ers ­deserve fur­ther inves­ti­ga­tions ­before ­their ­wide use in clin­i­cal prac­tice.