Endocrine Abstracts

Background: SPINET was a phase 3 trial (NCT02683941) in patients with well-differentiated, advanced bronchopulmonary neuroendocrine tumors (NETs; typical and atypical carcinoids [TCs and ACs]). During the double-blind (DB) period, patients were randomized (2:1) to receive lanreotide autogel/depot (LAN; 120 mg) or placebo (PBO) every 28 days; in the optional open-label (OL) phase, all patients received LAN. Recruitment was stopped early due to slow accrual; all eligible patient...

Background: High-grade neuroendocrine neoplasms (HG-NENs) are a heterogenous and biologically aggressive rare subset of NENs. Few therapeutic options are available to metastatic HG-NENs. To date, first line treatment is platinum- or temozolomide-based chemotherapy which provide modest benefits in overall survival (OS) and progression free survival (PFS). Given the promising activity of immunotherapy across several cancer types, our center initiated a phase II trial of pembroli...

Background: LA-SSA therapy, including octreotide long-acting release (LAR) and lanreotide depot (LAN), is recommended as first-line therapy for treatment of unresectable or metastatic NETs. Understanding treatment sequencing and dosing patterns of LA-SSAs is essential for clinical decision-making to provide value-based management of NET for both the patients and healthcare system. This study describes treatment patterns of LA-SSA therapy among privately insured patients with N...

Background: Extrapulmonary PD NECs carry a poor prognosis. Some studies suggest cisplatin is more appropriate for younger patients due to its increased potency and nephrotoxicity compared to carboplatin, but randomized trials are lacking. We aim to determine whether there is a difference in outcomes for cisplatin vs carboplatin while adjusting for possible confounding factors.Methods: We identified PD NEC patients at Mayo Clinic between 2000-2022. Kaplan...

Background: Multiple studies have shown that approximately 50-70% of patients with MEN1 die of causes directly related to MEN1 particularly gastroenteropancreatic (GEP) neuroendocrine tumors (NETs). While non-functional GEP-NETs are the most common in the general population, gastrinomas (40%) are the most common functional GEP-NETs in patients with MEN1. c-Met is a proto-oncogene that encodes for c-MET, a tyrosine kinase receptor which promotes tumor cell motility, proliferati...

Background: Surufatinib, an oral small molecule tyrosine kinase inhibitor, selectively inhibits vascular endothelial growth factor receptor 1, 2, and 3; fibroblast growth factor receptor 1; and colony-stimulating factor 1 receptor. Tislelizumab is a humanized immunoglobulin G4-variant anti-programmed cell death protein-1 monoclonal antibody. Combining surufatinib and tislelizumab may have synergistic effects, where inhibition of angiogenesis and stimulation of an immune respon...

Background: The treatment landscape for neuroendocrine tumors includes alkylating-agent chemotherapy and peptide receptor radiotherapy (PRRT) with 177Lu-Dotatate. The risk of MDS/AML associated with 177Lu-Dotatate is approximately 2-3%. Several small prior studies have suggested substantially higher rates of MDS/AML (approximately 10%) in patients who have also received alkylating agent chemotherapy with streptozocin or temozolomide, either combined with PRRT or sequentially. ...

Background: Immune checkpoint inhibitors have not been shown to be active in well-differentiated NETs, with response rates <5%. Lenvatinib is a multitargeted TKI which targets VEGF and FGF receptors and has been reported to be effective in pancreatic and gastrointestinal NETs (40% and 18.5% ORR, respectively). The combination of antiangiogenic and checkpoint inhibitor therapies can be synergistic in other cancers. We therefore evaluated the combination of lenvatinib and pe...

Background: Capecitabine and temozolomide (CAPTEM) is a common regimen for the treatment of metastatic, well-differentiated pancreatic neuroendocrine tumors (PNETs). However, it is unknown whether certain genomic profiles predict response to CAPTEM. PNETs often contain mutations in MEN1, ATRX, DAXX, and the PI3K/AKT/mTOR pathway. We sought to determine whether the mutational status of these genes may correlate with progression-free survival (PFS) on CAPTEM.<p clas...

Background: Pancreatic neuroendocrine neoplasms rarely secrete ACTH resulting in ectopic Cushing’s syndrome. Data are limited to case reports and very small series.Methods: Cases of ectopic Cushing’s syndrome were identified from a database of pancreatic NEN seen at the Moffitt Cancer Center between 1/2008 and 4/2022. Tumor characteristics, clinical signs and symptoms, therapies and outcomes were evaluated.Results: 13 pat...

Background: Oral octreotide capsules (OOC) are approved in the United Sates for long-term maintenance treatment in acromegaly patients who have previously responded to and tolerated injectable somatostatin analogs (SSAs, octreotide or lanreotide). Injectable SSAs are also approved and the standard of care in the treatment of carcinoid syndrome associated with neuroendocrine tumors (NET). Compared with acromegaly, patients with NET can require higher average doses of injectable...

Background: With the advent of new therapeutic modalities, the overall survival of neuroendocrine tumor (NET) patients has increased. However, the impact of the symptoms, treatments on the quality of life (QoL) of the patients, accessibility to health care, and financial toxicity are underreported in the literature. We have established a prospective NET biobank to capture the burden of the disease on patients’ daily life and the impact on their QoLM...

Background: Chromogranin A (CGA) and 5-HIAA are meaningful biomarkers in managing neuroendocrine tumors (NETs). CGA, though nonspecific, can reflect disease bulk and typically decreases after debulking surgery. 5-HIAA is specific to NETs though its measurement may require a special diet, a 24-hour urine collection, or specialized blood collection tubes; but usually decreases after debulking procedures. Serotonin, though useful in diagnosing NETs, is not followed as a biomarker...