by Vera Martinella
An extensive survey conducted in Italy answers some doubts of oncologists on the most suitable therapies for some patients: a multidisciplinary discussion of the individual case is necessary
Still difficult to diagnose and very heterogeneous from a clinical and biological point of view, neuroendocrine tumors are a group of neoplasms that register more than 2,600 new cases in Italy every year. Since these are very rare and complex diseases both to recognize and to treat, it is essential that the patient is assisted by a multidisciplinary team that discusses the individual clinical case and outlines the most suitable therapeutic plan. This is confirmed by a recent review conducted by the Italian Association of Medical Oncology (Aiom), published in the journal Cancer Treatment Reviews
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What are neuroendocrine tumors
Neuroendocrine tumors (Neuroendocrine tumors, NETs in English) are a heterogeneous group of neoplasms deriving from neuroendocrine cells, scattered practically everywhere in the human body: they are, in fact, specialized cells that function as part of both the nervous and endocrine systems, in the production of hormones. “Neuroendocrine tumors, of which there are numerous very different subtypes, are rare as they have an incidence of less than six new cases per 100,000 people per year,” explains Nicola Fazio, director of the digestive system and neuroendocrine tumors program at the Istituto European Institute of Oncology (IEO) in Milan —. The most frequent are those of the gastroenteropancreatic tract (about two thirds of cases), followed by broncho-pulmonary ones (20-30%) or other regions of the body (10%) such as skin, thyroid, parathyroid and adrenal glands. recognize them. In view of the rarity and biological and clinical heterogeneity of neuroendocrine tumors, the treatment of patients who are affected by them should be managed in a specialized and multidisciplinary setting”. In short, since these are infrequent and little known pathologies, it is difficult both to recognize them and to treat them correctly: therefore, the teamwork of several experts is needed to best assist each case.
The new survey answers the doubts
The new study (carried out thanks to the unconditional support of Ipsen SpA) was requested by the experts to answer questions on the role of the drugs octreotide and lanreotide (used in the treatment of NETs) in dubious situations. “Octreotide and lanreotide are two analogues of somatostatin that we have been using for years as therapies capable of blocking tumor growth and controlling some symptoms associated with the disease – explains Saverio Cinieri, national president of Aiom -. However, their use in some clinical settings for gastroenteropancreatic and lung neuroendocrine tumors is controversial. In fact, there is no universal agreement among specialists as the scientific evidence is not so clear-cut. Even the various international guidelines are sometimes discrepant with each other”. «With our publication we have critically analyzed the scientific evidence on eight particular clinical situations in which the use of somatostatin analogues is debated – continues Fazio -. It emerged that, unlike classic clinical situations where the use of these therapies is routine, there are particular contexts in which octreotide and lanreotide can determine benefits for selected patients, although the scientific evidence is modest. This type of case should be discussed within multidisciplinary groups dedicated to neuroendocrine tumors, including clinicians such as oncologist, endocrinologist, gastroenterologist, internist, nuclear doctor”.
Specialized hospitals in Italy
Although neuroendocrine tumors are malignant, in many cases they have a more indolent course than non-neuroendocrine tumors of the same organs and this allows many patients (even with advanced disease) to be able to live with the disease and the therapies for a long time. «However, having a correct diagnosis and being followed in a specialized center is an indispensable prerequisite – concludes Cinieri -. In Italy there are eight centers of excellence for the treatment of gastroenteropancreatic neuroendocrine tumors that have received certification from the European Society of Neuroendocrine Tumors. Furthermore, there are various hospital, university or research structures, in which there are mono or oligo-specialist skills for the treatment of these particular forms of cancer. They are complex neoplasms and against which important results have been obtained in the last 20 years. Greater coordination on the scientific research front is essential if we want to further increase survival rates».
August 9, 2023 (change August 9, 2023 | 07:51)
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