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J Thorac Dis. 2017 Nov;9(Suppl 15):S1501-S1510. doi: 10.21037/jtd.2017.06.14.

The role of multimodal treatment in patients with advanced lung neuroendocrine tumors.

Author information

1
Unit of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, Milan, Italy.
2
Department of Pathology, European Institute of Oncology, Milan, Italy.
3
Division of Nuclear Medicine, European Institute of Oncology, Milan, Italy.
4
Division of Radiotherapy, European Institute of Oncology, Milan, Italy.
5
Division of Hepatobiliopancreatic Surgery, European Institute of Oncology, Milan, Italy.
6
Division of Radiology, European Institute of Oncology, Milan, Italy.
7
Division of Interventional Radiology, European Institute of Oncology, Milan, Italy.
8
Division of Endoscopy, European Institute of Oncology, Milan, Italy.
9
Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
10
Division of Thoracic Medical Oncology, European Institute of Oncology, Milan, Italy.
11
Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan.
12
Inter-Hospital Pathology Division, Science and Technology Park, IRCCS MultiMedica, MIlan, Italy.

Abstract

Lung neuroendocrine tumors (NETs) comprise typical (TC) and atypical carcinoids (AC). They represent the well differentiated (WD) or low/intermediate grade forms of lung neuroendocrine neoplasms (NENs). Unlike the lung poorly differentiated NENs, that are usually treated with chemotherapy, lung NETs can be managed with several different therapies, making a multidisciplinary interaction a key point. We critically discussed the multimodal clinical management of patients with advanced lung NETs. Provided that no therapeutic algorithm has been validate so far, each clinical case should be discussed within a NEN-dedicated multidisciplinary team. Among the systemic therapies available for metastatic lung NETs everolimus is the only approved drug, on the basis of the results of the phase III RADIANT-4 trial. Another phase III trial, the SPINET, is ongoing comparing lanreotide with placebo. Peptide receptor radionuclide therapy and chemotherapy were not studied within phase III trials for lung NETs, and they have been reported to be active within retrospective or phase II prospective studies. Temozolomide and oxaliplatin are two interesting chemotherapeutic agents in lung NETs. While some European Institutions were certificated as Centers of Excellence for gastroenteropancreatic NENs by the European Neuroendocrine Tumor Society (ENETS), an equivalent ENETS certification for lung NENs does not exist yet. Ideally a lung NEN-dedicated multidisciplinary tumor board should include NEN-dedicated medical oncologists, thoracic medical oncologist, thoracic surgeons, pathologists, interventional radiologists, endocrinologists, radiotherapists, interventional pneumologists, nuclear physician.

KEYWORDS:

Lung NET; atypical carcinoid (AC); bronchopulmonary carcinoid; lung carcinoid; typical carcinoid

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

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