Format

Send to

Choose Destination
Endocr Connect. 2016 Sep;5(5):174-87. doi: 10.1530/EC-16-0043. Epub 2016 Aug 31.

A Delphic consensus assessment: imaging and biomarkers in gastroenteropancreatic neuroendocrine tumor disease management.

Author information

1
Uppsala UniversityUppsala, Sweden.
2
Erasmus Medical CenterRotterdam, Netherlands.
3
Memorial Sloan Kettering Cancer CenterNew York, New York, USA.
4
Wren LaboratoriesBranford, Connecticut, USA.
5
Netherlands Cancer InstituteAmsterdam, Netherlands.
6
University of BolognaBologna, Italy.
7
Zentralklinik Bad BerkaBad Berka, Germany.
8
Dana Farber Cancer InstituteBoston, Massachusetts, USA.
9
Charite HospitalBerlin, Germany.
10
University of Warmia and MazuryOlsztyn, Poland.
11
Ospedale San RaffaeleMilan, Italy.
12
IEO (European Institute of Oncology)Milan, Italy.
13
Imperial College LondonLondon, UK.
14
National Institutes of HealthBethesda, Maryland, USA.
15
Martini ZiekenhuisGroningen, Netherlands.
16
University Hospital FreiburgFreiburg, Germany.
17
Instituto Scientifico Romagnolo per lo Studio e la Cura dei TumoriMeldola, Italy.
18
Instituto Catala d'OncologiaBarcelona, Spain.
19
H. Lee Moffitt Cancer CenterTampa, Florida, USA.
20
University of VeronaVerona, Italy.
21
Univeristy of OxfordOxford, UK.
22
University of GroningenGroningen, Netherlands.
23
Medical University InnsbruckInnsbruck, Austria.
24
Copenhagen UniversityCopenhagen, Denmark imodlin@optonline.net.
25
Yale UniversityNew Haven, Connecticut, USA imodlin@optonline.net.

Abstract

The complexity of the clinical management of neuroendocrine neoplasia (NEN) is exacerbated by limitations in imaging modalities and a paucity of clinically useful biomarkers. Limitations in currently available imaging modalities reflect difficulties in measuring an intrinsically indolent disease, resolution inadequacies and inter-/intra-facility device variability and that RECIST (Response Evaluation Criteria in Solid Tumors) criteria are not optimal for NEN. Limitations of currently used biomarkers are that they are secretory biomarkers (chromogranin A, serotonin, neuron-specific enolase and pancreastatin); monoanalyte measurements; and lack sensitivity, specificity and predictive capacity. None of them meet the NIH metrics for clinical usage. A multinational, multidisciplinary Delphi consensus meeting of NEN experts (n = 33) assessed current imaging strategies and biomarkers in NEN management. Consensus (>75%) was achieved for 78% of the 142 questions. The panel concluded that morphological imaging has a diagnostic value. However, both imaging and current single-analyte biomarkers exhibit substantial limitations in measuring the disease status and predicting the therapeutic efficacy. RECIST remains suboptimal as a metric. A critical unmet need is the development of a clinico-biological tool to provide enhanced information regarding precise disease status and treatment response. The group considered that circulating RNA was better than current general NEN biomarkers and preliminary clinical data were considered promising. It was resolved that circulating multianalyte mRNA (NETest) had clinical utility in both diagnosis and monitoring disease status and therapeutic efficacy. Overall, it was concluded that a combination of tumor spatial and functional imaging with circulating transcripts (mRNA) would represent the future strategy for real-time monitoring of disease progress and therapeutic efficacy.

KEYWORDS:

CT scan; CTC; Delphic consensus; MRI; NETest; PET; RECIST; biomarker; carcinoid; imaging; mRNA; multianalyte; neuroendocrine tumor; somatostatin

Supplemental Content

Full text links

Icon for Sheridan PubFactory Icon for PubMed Central
Loading ...
Support Center