Bronchial Carcinoids: From Molecular Background to Treatment Approach

Area of Science:

• Oncology
• Genetics
• Molecular Biology

Background:

• Bronchial carcinoids (BCs) are neuroendocrine tumors requiring better understanding of their genetic and molecular underpinnings.
• Distinguishing BCs from other lung neuroendocrine neoplasms is crucial, as progression from NET to NEC is not expected.
• Genetic alterations like MEN1 mutations and ATRX mutations are associated with poorer prognosis in BCs.

Purpose of the Study:

• To comprehensively review the molecular and genetic landscape of bronchial carcinoids.
• To discuss current and emerging treatment strategies for localized and advanced BCs.
• To outline associated paraneoplastic syndromes.

Main Methods:

• Review of existing literature on bronchial carcinoid genetics, molecular biology, and treatment.
• Analysis of genetic mutations (e.g., MEN1, ATRX) and their prognostic implications.
• Summary of therapeutic targets, including the PI3K/AKT/mTOR pathway, and systemic treatment options.

Main Results:

• MEN1 gene mutations/deletions and ATRX mutations are linked to poor prognosis and shorter survival in BCs.
• The PI3K/AKT/mTOR pathway is a targetable mutation in a significant subset of typical and atypical carcinoids.
• While surgery is curative for localized BCs, advanced disease management involves diverse systemic therapies with varying evidence.

Conclusions:

• Genetic profiling of BCs is essential for predicting disease progression and tailoring treatments.
• Targeting pathways like PI3K/AKT/mTOR offers potential therapeutic avenues.
• A multidisciplinary approach is necessary for managing advanced BCs, considering the heterogeneity of available treatments.