Miguel Bronchud, Veteran Cancer Clinician and Researcher and Co-Founder of Regenerative Medicine Solutions, shared on LinkedIn:
“Symptom Management for Well-Differentiated Gastroenteropancreatic Neuroendocrine Tumors: ASCO Guideline
American Society of Clinical Oncology.
Neuroendocrine neoplasms (NENs) include poorly differentiated neuroendocrine carcinomas, well-differentiated neuroendocrine tumors (NETs), and mixed neuroendocrine non-NENs.
The focus of this guideline is on grade 1 (G1) to grade 3 (G3) well-differentiated NETs, which account for approximately 80%-90% of NENs.
Historically, NETs were considered rare, but incidence and prevalence rates have been increasing in recent decades because of improvement in diagnosis, more NETs being incidentally diagnosed, stage migration, and longer survival.
In the USA, the age-adjusted incidence of NETs per 100,000 persons rose from 4.90 in 2000 to 8.19 in 2018
As these tumors grow and metastasize, there is more potential for patients to experience symptoms related to secretion of hormones, which can cause a wide range of symptoms, depending on the type of hormone that is secreted.
In a study of data gathered between 2000 and 2011, 32.4% of 2,211 patients with small bowel NETs had symptoms of carcinoid syndrome.
Approximately 10%-20% of patients with pancreatic NETs (panNETs)are reported to have one of several clinical syndromes as a result of hormone excess.
These statistics may underestimate the prevalence of functional NETs that are associated with clinical symptoms related to hormone secretion because many patients experience nonspecific symptoms for several years before diagnosis, and these symptoms may be attributed to other causes.
The focus of this guideline is on management of symptoms related to metastatic NETs that arise in the GI tract and pancreas (gastroenteropancreatic neuroendocrine tumors [GEP-NETs]).
This clinical practice guideline is intended to raise awareness of NETs and treatment options in the oncology community.
It includes options for surgical management, medical management, liver-directed therapy, and other interventions for metastatic functioning GEP-NETs.
The main outcomes of interest are reduction in symptoms, reduction in adverse events with treatment, and overall improvement, stabilization, or lengthened time to deterioration of quality of life.
A previously published ASCO guideline includes recommendations for systemic therapy .
What are the recommended treatment options for management of symptoms of functional GEP-NETs, including carcinoid syndrome, carcinoid heart disease, and functional panNETs?
- Small bowel tumors: Somatostatin analogs (SSAs), telotristat ethyl, surgery, liver-directed therapy (embolization), systemic therapy options, including chemotherapy and peptide receptor radionuclide therapy (PRRT), and others.
- panNETs: SSAs, surgery, liver-directed therapy, systemic therapy options such as PRRT, chemotherapy, targeted therapy, and options to treat symptoms specific to each panNET syndrome.”
You can also read: RYZ101 Improves PFS in Phase 3 ACTION-1 Trial for GEP-NETs After Lutetium-177 Therapy
