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Landscape and Future Perspectives of Immunotherapy in Neuroendocrine Neoplasia
Ilaria Maggio1, Lisa Manuzzi1, Giuseppe Lamberti1,2
1Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Alma Mater Studiorum University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
Background:
Neuroendocrine neoplasms are rare entities consisting of a heterogeneous group of tumors that can originate from neuroendocrine cells present in the whole body. Their different behavior, metastatic potential, and prognosis are highly variable, depending on site of origin, grade of differentiation, and proliferative index. The aim of our work is to summarize the current knowledge of immunotherapy in different neuroendocrine neoplasms and its implication in clinical practice.
Results:
Several studies evaluated the efficacy and safety of immunotherapy in neuroendocrine neoplasms, in any setting of treatment, alone or in combination. Studies led to approval in neuroendocrine neoplasia of the lung, in combination with chemotherapy as first-line treatment or as a single-agent in a third-line setting, and Merkel cell carcinoma as a single agent. Results in other settings have been disappointing so far.
Conclusions:
Immunotherapy seems a valid treatment option for high grade, poorly differentiated neoplasms. Future trials should explore the combination of immunotherapy with other agents, such as anti-angiogenic or other immunotherapy agents, in order to evaluate potential efficacy in low and intermediate grades, well differentiated tumors.
Insights
Immunotherapy shows promise for high-grade neuroendocrine neoplasms, with approved treatments for lung neuroendocrine tumors and Merkel cell carcinoma. Further research is needed for lower-grade tumors.
Area of Science:
- Oncology
- Immunology
- Cancer Research
Background:
- Neuroendocrine neoplasms (NENs) are rare, heterogeneous tumors with variable prognosis.
- Tumor behavior depends on origin, grade, and proliferation index.
- Current knowledge on immunotherapy for NENs needs summarization for clinical practice.
Purpose of the Study:
- To summarize current knowledge on immunotherapy in various neuroendocrine neoplasms.
- To discuss the implications of immunotherapy in clinical practice for NENs.
Main Methods:
- Review of studies evaluating immunotherapy efficacy and safety in neuroendocrine neoplasms.
- Analysis of approved indications and treatment settings.
Main Results:
- Immunotherapy is approved for lung neuroendocrine neoplasms (in combination with chemotherapy or as a third-line monotherapy) and Merkel cell carcinoma (as monotherapy).
- Efficacy in other neuroendocrine neoplasm settings has been limited.
- Immunotherapy appears effective in high-grade, poorly differentiated NENs.
Conclusions:
- Immunotherapy is a viable option for high-grade, poorly differentiated neuroendocrine neoplasms.
- Future trials should investigate immunotherapy combinations (e.g., with anti-angiogenics) for low- and intermediate-grade NENs.
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