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New clinical trials for the treatment of neuroendocrine tumors
E Bajetta1, E Bichisao, S Artale
1Unit of Oncology B, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.
Abstract:
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.
Insights
Neuroendocrine tumors (NETs) show increasing interest in oncology. While surgery is preferred, new long-acting formulations of somatostatin analogues like lanreotide and octreotide show promising results for NET treatment.
Area of Science:
- Oncology
- Endocrinology
- Gastroenterology
Background:
- Neuroendocrine tumors (NETs) are gaining attention in oncology, with recent data suggesting shifts in carcinoid tumor proportions.
- Despite being indolent and difficult to diagnose, the true incidence of NETs may be underestimated.
- Surgery is the primary treatment, but complete cure is challenging, and cytotoxic chemotherapy offers modest benefits for high-grade NETs.
Purpose of the Study:
- To review the current landscape of neuroendocrine tumor management.
- To highlight recent advancements in hormonal therapy, specifically long-acting somatostatin analogues.
- To discuss challenges in conducting clinical trials for neuroendocrine tumors.
Main Methods:
- Review of recent clinical trials and literature on neuroendocrine tumors.
- Focus on long-acting formulations of somatostatin analogues: lanreotide prolonged-release (PR) and octreotide long-acting release (LAR).
- Discussion of diagnostic challenges and the role of biological markers.
Main Results:
- Recent trials using long-acting formulations of lanreotide (30 mg every 2 weeks) and octreotide (10, 20, or 30 mg every 28 days) demonstrate very promising outcomes.
- These formulations represent a significant advancement in the hormonal treatment of neuroendocrine tumors.
- The study acknowledges the difficulty in conducting new clinical trials due to methodological and clinical complexities.
Conclusions:
- Long-acting somatostatin analogues (lanreotide PR and octreotide LAR) offer promising therapeutic options for neuroendocrine tumors.
- Further investigation into biological markers is warranted before widespread clinical adoption.
- Despite treatment advances, challenges in clinical trial design and achieving complete cures persist in NET management.