Advances in the Diagnosis and Management of Well-Differentiated and Intermediate-Differentiated Neuroendocrine Tumors of the Lung

Edward M. Wolin

Research output: Contribution to journalReview article

22 Citations (Scopus)

Abstract

Neuroendocrine tumors (NETs) are a rare, heterogeneous group of malignancies that arise from neuroendocrine cells throughout the body, with the lungs and GI tract being the most common sites of origin. Despite increasing incidence, awareness of lung NETs remains low among thoracic specialists who are often involved in the assessment and early treatment of these patients. Successful treatment requires accurate and timely diagnosis; however, classification can be challenging, particularly for well-differentiated and intermediate-differentiated lung NET types (typical carcinoids [TC] and atypical carcinoids [AC]). Diagnosis and management of lung NETs are further complicated by the nonspecificity of symptoms, variable natural history, and lack of high-level clinical evidence; a multidisciplinary approach is required, which has been shown to improve prognosis. Currently, surgery remains the only curative option for TC/AC. Inconsistencies between guideline recommendations for systemic therapies, especially for chemotherapy, result in a lack of consensus on a standardized treatment for unresectable disease. Recent data from the Phase III RAD001 in Advanced Neuroendocrine Tumors, Fourth Trial (RADIANT-4), which contained a large population of patients with advanced, well-differentiated, nonfunctional lung NETs in addition to those with GI NETs, found a reduced risk of disease progression and death with everolimus compared with placebo, leading to US approval of everolimus in these patient populations. This study is the first high-level therapeutic evidence in patients with TC/AC, and everolimus is currently the only agent approved for treatment of TC/AC. Increased awareness, prompt diagnosis, and additional adequately powered controlled clinical trials of patients with well-differentiated and intermediate-differentiated lung NETs are needed to further improve evidence-based care.

Original languageEnglish (US)
Pages (from-to)1141-1146
Number of pages6
JournalChest
Volume151
Issue number5
DOIs
StatePublished - May 1 2017

Fingerprint

Neuroendocrine Tumors
Carcinoid Tumor
Lung
Therapeutics
Neuroendocrine Cells
Controlled Clinical Trials
Natural History
Population
Disease Progression
Gastrointestinal Tract
Thorax
Placebos
Guidelines
Drug Therapy
Everolimus
Incidence

Keywords

  • atypical carcinoid
  • lung NET
  • pulmonary neuroendocrine tumors
  • RADIANT-4
  • typical carcinoid

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Advances in the Diagnosis and Management of Well-Differentiated and Intermediate-Differentiated Neuroendocrine Tumors of the Lung. / Wolin, Edward M.

In: Chest, Vol. 151, No. 5, 01.05.2017, p. 1141-1146.

Research output: Contribution to journalReview article

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