Endocrine Abstracts (2017) 49 MTE8 | DOI: 10.1530/endoabs.49.MTE8

How best to manage neuroendocrine tumours? - Towards a new algorithm

Alicja Hubalewska-Dydejczyk


Poland.


During the last couple of years an essential increase of newly diagnosed NENs has been observed, however it should be underlined that many cases represent new challenges for the medical staff. Development of personalized approach to NEN patients on the basis of knowledge rapidly coming from genetic/molecular research, improvement of biochemical/imaging diagnostic methods and availability of more efficient therapeutic options, means that existing guidelines are still being changed. However, the questions: ‘what of the future hold for NEN?’ and ‘how will future achievements influence the new algorithm?’ remain open. In the majority of patients the overall prognosis depends on the grade (G) and stage (TNM) of the tumour. Recently proposed classification of NENs divides additionally G3 NENs into NET G3a and G3b neuroendocrine cancers. Ki-67 is currently the main prognostic index which drives the management of all NENs, nevertheless it should be stressed that very often patient outcomes are difficult to foresee and the lack of response to therapeutic treatment regiments remains unpredictable so the identification of other prognostic factors would be of great help and it would make diagnostic and therapeutic decisions more appropriate. At present chromogranin A, urinary 5-HIAA and tumour specific hormones in secreting NENs are widely used as biomarkers. One should bear in mind that surgery is the only possible curative method in NENs however, half of the patients have metastases at presentation and unknown primary focus can also be challenging. Therefore, the development of fast and accurate imaging procedures (endoscopies, USG, CT/MRI and the implementation of the different radiolabelled compounds targeting various membrane/intracellular receptors/metabolic pathways (PET/SPECT-CT/MRI) is necessary. Antiproliferative therapy with SSA, TKI, PRRT and cytotoxic therapy should be given rather as sequential monotherapy than a combination one. Based on clinical cases of patients with NENs in different locations and at a different stage of the disease the different diagnostic/therapeutic options will be discussed during the Meeting.

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