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Neuroendocrinal Tumors : A Case of Mistaken Identity.

Neuroendocrinal Tumors : A Case of Mistaken Identity. Mohamed Abdulla M.D. Professor of Clinical Oncology, Kasr El-Aini School of Medicine Cairo University. www.oncologyclinic.org mohamed.abdulla@oncologyclinic.org. Alexandria – EGSSO – 24/06/2010. ?. Objectives:. Basic Information.

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Neuroendocrinal Tumors : A Case of Mistaken Identity.

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  1. Neuroendocrinal Tumors: A Case of Mistaken Identity. Mohamed Abdulla M.D. Professor of Clinical Oncology, Kasr El-Aini School of Medicine Cairo University. www.oncologyclinic.org mohamed.abdulla@oncologyclinic.org. Alexandria – EGSSO – 24/06/2010

  2. ?

  3. Objectives: • Basic Information. • Magnitude of The Problem. • Pitfalls in Diagnosis. • What is New in Therapeutic Strategies.

  4. Origin & Classification:

  5. Origin & Classification:

  6. Natural History: Indolent Indolent Aggressive Resistant to ttt • Clinical Manifestations are Vague. • Advanced & Metastatic at Presentation. • Complete Surgical Removal is Questionable. • The Available Therapeutic Options are not Effective. Cure Dismal Outcome

  7. Staging & Survival: Yao et al. JCO. 2008, 26(18)3063-72

  8. Staging & Survival: G 1 - 2 Yao et al. JCO. 2008, 26(18)3063-72

  9. Staging & Survival: G 3 - 4 Yao et al. JCO. 2008, 26(18)3063-72

  10. Neuroendocrinal Tumors: The Hassle

  11. Neuroendocrinal Tumors: Yao et al. JCO. 2008, 26(18)3063-72

  12. Neuroendocrinal Tumors: Yao et al. JCO. 2008, 26(18)3063-72

  13. Neuroendocrinal Tumors: Yao et al. JCO. 2008, 26(18)3063-72

  14. Neuroendocrinal Tumors: American Cancer Society. Cancer prevalence: how many people have cancer? Updated October 30, 2008. Accessed May 7, 2009.

  15. Neuroendocrinal Tumors: Increased Incidence?? Better Understanding??

  16. Critical Biomarkers:1. Plasma Chromogranin (CgA) • A Measure of Endocrine Tissues. • Non-Specific • False Positive Results: • Proton Pump Inhibitors. • Atrophic Gastritis. • Renal Impairment.

  17. Critical Biomarkers:2. Urinary 5-HIAA: Compromised Survival

  18. Looking at Neuroendocrine Tumors: • Octreoscan. • SPECT/CT Hybrid Imaging. • MIBG. • CT/MRI. • Endoscopic Ultrasound. • Capsule Endoscopy.

  19. Neuroendocrinal Tumors:Management:

  20. Neuroendocrinal Tumors:Conventional Medical Treatment: • Sterptozotocin. • Anthracyclins. • Flouroupyremidines. • Dacarbazine.

  21. Neuroendocrinal Tumors:Somatostatin analogues: Symptomatic Relief 60% sst1 sst2 sst3 sst4 sst5 Tumor Shrinkage 5% Anti-proliferative Effect Blocking of Hormone Synthesis

  22. Neuroendocrinal Tumors:Somatostatin analogues:PROMID Study (2009): • ++ PFS (15.6 vs 5.9 months). • SD in 67%. • Functioning and Non-Functioning Tumors.

  23. Neuroendocrinal Tumors:Molecular Events & Therapeutic Implications:1. Angiogenesis: vHL Gene Oxygenation Hypoxia Bevacizumab + Octreotid LAR INF + Octreotid LAR PFS 96% 68% Angiogenesis +++ VEGF

  24. Neuroendocrinal Tumors:Molecular Events & Therapeutic Implications:2. mTOR Inhibitor: Mammalian Target of Rapamycin Altered Metabolism Cellular Growth Resistance to Apoptosis Protein Synthesis ++ Proliferation Autophagy

  25. Neuroendocrinal Tumors:Molecular Events & Therapeutic Implications:2. mTOR Inhibitor: RAD 001 (Everolimus): • PR 13% • SD 74%. • DP 13%.

  26. Neuroendocrinal Tumors:Molecular Events & Therapeutic Implications:2. mTOR Inhibitor: RADIANT – 1 Advanced Chemo-Resistant Neuroendocrinal Tumors RAD001 RAD001 Octreotid LAR Radiological Response: 77% 84% PFS: 9.7 ms. 16.7 ms. > 50% reduction in > 50% of Patients

  27. Quiz?? Adenocarcinoma NET

  28. Final Take Home Message: • NET not rare. • Surgery is the Cornerstone in Curative Management. • Serum Biomarkers Are Still There to Share. • Tissue Markers Should be more Highlighted. • Molecular Targeted Therapies are The Hope for Tomorrow.

  29. Thank you

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