TITLE:
Update on Therapeutic Strategy in Lung Carcinoids
AUTHORS:
Sara Pusceddu, Milena Vitali, Eva Haspinger, Luca Tavecchio, Riccardo Giovannetti, Andrea Bille, Laura Concas, Marina Garassino, Massimo Milione, Filippo de Braud, Roberto Buzzoni
KEYWORDS:
Bronchial; Pulmonary; Carcinoids; Neuroendocrine Tumours
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.4 No.10,
December
13,
2013
ABSTRACT: An
estimated 25% to 30% of all neuroendocrine tumors (NETs) have their origin in
the bronchial tree and into the lungs. Although lung
NETs account for less than 1% of all pulmonary malignancies, the incidence of
these neoplasms has risen precipitously since the mid 1970s. Currently,
according to the 2004 World Health Organization categorization, these tumors
are separated into 4 subtypes characterized by increasing biologic
aggressiveness: low-grade typical carcinoid (TC), intermediate-grade atypical
carcinoid (AC), high-grade large-cell neuroendocrine carcinoma (LCNEC) and
small-cell carcinoma (SCLC). Surgery
is the treatment of choice for typical and atypical carcinoid lung NETs with
loco-regional disease. At diagnosis up to 64% of patients with atypical
carcinoid lung NETs present with lymph node metastases, and 5-year survival
ranges from 61% to 88%. In contrast, lymph node metastases are present in fewer
than 15% of typical carcinoid lung NETs, and 5-year survival exceeds 90%. To date, there is no recognized
standard of treatment for advanced carcinoid lung NETs. In recent years only
two trials reported intriguing results
regarding lung NETs: a phase 2 retrospective study of dacarbazine derivative
temozolomide and the phase 3, RADIANT-2 trial in advanced NETs. Successful
management requires a multidisciplinary team management. This review is
restricted to typical/atypical NETs.