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A Practical Guide for the Production and PET/CT Imaging of 68Ga-DOTATATE for Neuroendocrine Tumors in Daily Clinical Practice
Published on: April 17, 2019
[Mid gut neuroendocrine tumors: News on medical treatment]
Marie Dior1, Johann Dreanic1, Caroline Prieux-Klotz1
1CHU Cochin, AP-HP, service de gastroentérologie, d'endoscopie digestive et d'oncologie digestive, 27, rue du Faubourg-St.-Jacques, 75014 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, faculté de médecine, 75006 Paris, France.
Context:
Mid gut neuroendocrine tumors (NET) are rare tumors whose incidence is increasing. Curative surgery remains the gold standard for the treatment of NETs of the small intestine. Surgery should be considered as soon as possible even if a metastatic stage is diagnosed. The management of unresectable well-differentiated metastatic NETs of the small intestine recently changed with the publication of trials demonstrating the benefit of targeted therapies and metabolic radiotherapy, leading to a change of practices and update of French and international recommendations.
Objective:
The objective of this review is to present the recent data consisting of three phase III studies, which modify the management of well-differentiated metastatic midgut NETs and make an inventory of the available treatment options.
Documentary Sources:
The documentary sources used were gathered through the PubMed website using keyword searching (neurendocrine tumor, mid gut, treatment). We also referred to recommendations of the European Society of neuroendocrine tumors (ENETS) trials presented at ESMO Congress 2015 (European Society for Medical Oncology).
Study Selection:
We excluded studies of exclusive extra-digestive NETs, poorly differentiated NETs, surgical treatments and phase I studies.
Results:
We discussed three randomized phase III trials: CLARINET, RADIANT and NETTER studies. These studies demonstrated the efficacy of respectively somatostatin analogues, mTOR inhibitors and metabolic radiotherapy.
Conclusion:
This review highlights the validation by randomized studies of an mTOR inhibitor and metabolic radiotherapy in metastatic non-pancreatic digestive NETs unresectable well-differentiated grade of G1/2 in progression under somatostatin analogues.
Insights
New treatments like mTOR inhibitors and radiometabolic therapy are now validated for advanced midgut neuroendocrine tumors (NETs) progressing on somatostatin analogues.
Area of Science:
- Oncology
- Gastroenterology
- Endocrinology
Background:
- Midgut neuroendocrine tumors (NETs) are rare but increasing in incidence.
- While surgery is curative for localized disease, metastatic NETs require systemic treatment.
- Recent trials have reshaped the management of unresectable, well-differentiated metastatic midgut NETs.
Purpose of the Study:
- To review recent phase III trial data impacting the management of metastatic midgut NETs.
- To summarize current treatment options for well-differentiated metastatic midgut NETs.
Main Methods:
- Literature search on PubMed using keywords: neuroendocrine tumor, mid gut, treatment.
- Inclusion of European Society of Neuroendocrine Tumors (ENETS) recommendations and ESMO Congress 2015 data.
- Exclusion of studies on extra-digestive NETs, poorly differentiated NETs, surgical treatments, and phase I trials.
Main Results:
- Three key phase III trials (CLARINET, RADIANT, NETTER) were analyzed.
- Somatostatin analogues, mTOR inhibitors, and metabolic radiotherapy demonstrated significant efficacy.
- These therapies offer new options for advanced midgut NETs.
Conclusions:
- mTOR inhibitors and metabolic radiotherapy are validated for unresectable, well-differentiated metastatic non-pancreatic digestive NETs (G1/2).
- These treatments are effective in patients progressing on somatostatin analogues.
- Updated guidelines reflect these advancements in midgut NET management.
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