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Systemic therapeutic options for carcinoid
Marianne Pavel1, Mark Kidd, Irvin Modlin
1Charité University Medicine, 13353 Berlin, Germany. marianne.pavel@charite.de
Abstract:
"Carcinoids" are mostly slow-growing neuroendocrine neoplasms (NENs) with low proliferative activity. A wide range of therapeutic options with variable efficacy exist, including locoregional ablative strategies. Thereafter, some patients may not require medical therapy for years depending on the rate of progression or recurrence. However, the majority of patients require systemic treatment and therein lies the dilemma, since no antiproliferative agent is currently approved for carcinoids. Somatostatin analogs (SSAs), and to a lesser extent interferon-alpha, are standard therapy for carcinoids associated with the carcinoid syndrome. These drugs have some antiproliferative efficacy. SSAs rarely lead to tumor remission but may modestly prolong time to tumor progression. Chemotherapy is of limited value in carcinoids with low proliferation indices but may be useful in higher grade tumors. Peptide receptor-targeted radionuclide therapy may be of benefit and is mostly used after medical therapies fail. However, it is considered an investigational modality. More recently, targeted drugs such as mammalian target of rapamycin (mTOR) inhibitors and anti-angiogenics have been investigated. Objective remissions are rare. Their value remains to be rigorously elucidated. Increased efficacy requires a better understanding of the underlying tumor biology and identification of molecular pathological criteria to allow appropriate preselection of candidates for targeted therapies.
Insights
Carcinoid tumors, a type of neuroendocrine neoplasm, present treatment challenges. While some therapies offer modest benefits, effective systemic treatments are lacking, necessitating further research into targeted therapies for neuroendocrine neoplasms.
Area of Science:
- Oncology
- Molecular Biology
- Endocrinology
Background:
- Carcinoids are slow-growing neuroendocrine neoplasms (NENs) with limited systemic treatment options.
- Current therapies like somatostatin analogs (SSAs) offer modest antiproliferative effects and prolong progression-free survival but rarely induce remission.
- Chemotherapy has limited utility in low-grade carcinoids, and radionuclide therapy is investigational.
Purpose of the Study:
- To review current therapeutic strategies for carcinoid tumors.
- To highlight the unmet need for effective systemic antiproliferative agents.
- To discuss emerging targeted therapies and the importance of understanding tumor biology.
Main Methods:
- Literature review of therapeutic options for carcinoid tumors.
- Analysis of the efficacy and limitations of existing treatments.
- Discussion of novel therapeutic approaches, including targeted drugs and molecular criteria for patient selection.
Main Results:
- Somatostatin analogs and interferon-alpha are standard for carcinoid syndrome but have limited antiproliferative efficacy.
- Chemotherapy is mainly useful for higher-grade tumors.
- Emerging targeted therapies (mTOR inhibitors, anti-angiogenics) show rare objective remissions and require further validation.
Conclusions:
- Effective systemic antiproliferative agents for carcinoids are lacking.
- Further research into neuroendocrine neoplasm biology is crucial for developing targeted therapies.
- Identifying molecular markers is essential for preselecting patients for novel treatments.
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