Page 86 - Read Online
P. 86
high RR suggested that prolonged administration of TMZ Patient consent
can induce a depletion of MGMT in favor of TMZ itself. No patient involved.
Despite study limitations (small number, heterogeneity),
the high RR suggests the need to investigate this schedule Ethics approval
in a more homogeneous population (as for primary tumor This article does not contain any studies with human
site and biological characteristics) in order to confirm the participants or animals.
effectiveness of TMZ based-chemotherapy and validate
the predictive role of MGMT. REFERENCES
Chemotherapy in thoracic NETs 1. Swarts DR, Ramaekers FC, Speel EJ. Molecular and cellular
Due to their rarity, thoracic NENs (typical and biology of neuroendocrine lung tumors: evidence for separate
atypical carcinoids) are usually included in studies 2. biological entities. Biochim Biophys Acta 2012;1826:255-71.
WHO classification of Tumours of the Digestive System. In:
with chemotherapy designed for NENs derived from Bosman FT, Carneiro F, Hruban RH, Theise ND, editors. World
other anatomical regions. Thus, there is no standard Heath Organization Classification of Tumours, Lyon, France:
chemotherapy regimen for thoracic NENs and any International Agency for Research on Cancer (IARC); 2010:417.
therapeutic results do not appear homogeneous. Moreover, 3. Modlin IM, Pavel M, Kidd M, Gustaffsson BI. Review article
given their low proliferative activity, carcinoids are somatostatin analogues in the treatment of gastroenteropancreatic
generally considered to be chemo-resistant. Single- neuroendocrine (carcinoid) tumours. Aliment Pharmacol Ther
[71]
agent chemotherapy has shown no more than 20% overall 4. 2010;31:169-88.
Yao JC, Shah MH, Ito T, Bohas CL, Wolin EM, Van Cutsem E,
ORR, so mono-chemotherapy is suggested for pretreated Hobday TJ, Okusaka T, Capdevila J, de Vries EG, Tomassetti
patients or patients with poor performance status or P, Pavel ME, Hoosen S, Haas T, Lincy J, Lebwohl D, Öberg K;
severe comorbidities. Older phase II or III trials have been RAD001 in Advanced Neuroendocrine Tumors, Third Trial
published but they were not considered homogeneous in (RADIANT-3) Study Group. Everolimus for advanced pancreatic
terms of population and response evaluation criteria due neuroendocrine tumors. N Engl J Med 2011;364:514-23.
to poorly definition. The drugs mostly used as single- 5. Capdevila J, Salazar R, Halperin I, Abad A, Yao JC. Innovations
agent are 5-FU, CDDP, carboplatin, irinotecan, TMZ, therapy: mammalian target of rapamycin (mTOR) inhibitors for
the treatment of neuroendocrine tumors. Cancer Metastasis Rev
gemcitabine, VP-16, doxorubicin, STZ, dacarbazine, 2011;30 Suppl 1:27-34.
paclitaxel, docetaxel, and pemetrexed. Poly-chemotherapy 6. Bajetta E, Catena L, Fazio N, Pusceddu S, Biondani P, Bianco G,
is able to produce a radiological PR in only 5-10% of Ricci S, Aieta M, Pucci F, Valente M, Bianco N, Mauri CM, Spada
patients, but with symptomatic responses in 40-60% F. Everolimus combination with octreotide long-acting repeatable
of cases. However, these results are extrapolated from in a first-line setting for patients with neuroendocrine tumours.
studies including patients with NENs derived from any 7. Cancer 2014;120:2457-63.
Raymond E, Dahan L, Raoul JL, Bang YJ, Borbath I, Lombard-
anatomical site, reducing the levels of trial evidence, Bohas C, Valle J, Metrakos P, Smith D, Vinik A, Chen JS, Hörsch
even for well-conducted study, and with low probability D, Hammel P, Wiedenmann B, Van Cutsem E, Patyna S, Lu DR,
of bias. A specific study of bronchial carcinoids was Blanckmeister C, Chao R, Ruszniewski P. Sunitinib malate for
recently published that examined TMZ as monotherapy the treatment of pancreatic neuroendocrine tumors. N Engl J Med
[72]
in 31 progressive metastatic bronchial carcinoid patients. 2011;364:501-13.
The treatment was active, showing 66% ORR, and well 8. Kulke MH, Lenz HJ, Meropol NJ, Posey J, Ryan DP, Picus J,
tolerated. However, combining regimens with other agents Bergsland E, Stuart K, Tye L, Huang X, Li JZ, Baum CM, Fuchs
CS. Activity of sunitinib in patients with advanced neuroendocrine
should be further studied. tumors. J Clin Oncol 2008;26:3403-10.
9. Bajetta E, Catena L, Valente M, Bianco N, Bellomo F, Bombardieri
CONCLUSION E. New perspectives in the treatment of neuroendocrine tumours.
Anticancer Res 2012;32:4193-200.
In conclusion, many drugs have shown activity but many 10. Sowa-Staszczak A, Pach D, Chrzan R, Trofimiuk M, Stefańska
questions still remain: which drugs to use, which schedule, A, Tomaszuk M, Kołodziej M, Mikołajczak R, Pawlak D,
timing and, above all, which predictors can guide clinicians Hubalewska-Dydejczyk A. Peptide receptor radionuclide therapy as
in the choice of chemotherapy. Despite the complexity and a potential tool for neoadjuvant therapy in patients with inoperable
neuroendocrine tumours (NETs). Eir J Nucl Med Mol Imaging
the heterogeneity of these tumors, the main challenge in 2011;38:1669-74.
the near future will be to design clinical trials that will 11. Strosberg J, Kvols L. Antiproliferative effect of somatostatin
answer these questions. It is also very important that analogs in gastroenteropancreatic neuroendocrine tumors. World J
the therapeutic decision only be achieved as part of a Gastroenterol 2010;16:2963-70.
multidisciplinary program. 12. Florio T. Somatostatin/somatostatin receptor signalling:
phosphotyrosine phosphatase. Mol Cell Endocrinol 2008;286:40-8.
Financial support and sponsorship 13. Florio T, Yao H, carey KD, Dillon TJ, Stork PJ. Somatostatin
Nil. activation of mitogen-activated protein kinase via somatostatin
receptor 1 (SSTR1). Mol Endocrinol 1999;13:24-37.
14. Serri O, Brazeau P, Kachra Z, Posner B. Octreotide inhibits
Conflicts of interest insulin-like growth factor-1 hepatic gene expression in the
There are no conflicts of interest. hypophysectomized rat: evidence for a direct and indirect
318
Journal of Cancer Metastasis and Treatment ¦ Volume 2 ¦ August 31, 2016 ¦