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Demir Gündoğan B, Sağcan F, Tuğ Bozdoğan S, Balcı Y, Tuncel Daloğlu F, Çıtak EC. Vandetanib in a Child Affected by Neurofibromatosis Type 1 and Medullary Thyroid Carcinoma with Both NF1 and Homozygous RET Proto-oncogen Germ-line Mutations. J Clin Res Pediatr Endocrinol 2021; 13:342-346. [PMID: 32702947 PMCID: PMC8388045 DOI: 10.4274/jcrpe.galenos.2020.2020.0051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Cases of neurofibromatosis type 1 (NF1)-associated medullary thyroid carcinoma (MTC) or C-cell hyperplasia are rarely associated with other endocrine tumors or cases with a multiple endocrine neoplasia type 2. In these patients, mutations were detected in the NF1 gene but no mutations were detected in the RET gene. Although vandetanib has been shown to improve progression-free survival in adults with advanced MTC, data in pediatric patients are limited. Herein, we report the use and outcome of vandetanib in a pediatric MTC case in which NF1 gene and RET proto-oncogen mutation were identified together.
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Affiliation(s)
| | - Fatih Sağcan
- Mersin University Faculty of Medicine, Department of Pediatric Oncology, Mersin, Turkey
| | - Sevcan Tuğ Bozdoğan
- Çukurova University Faculty of Medicine, Department of Medical Genetics, Adana, Turkey
| | - Yüksel Balcı
- Mersin University Faculty of Medicine, Department of Radiology, Mersin, Turkey
| | | | - Elvan Cağlar Çıtak
- Mersin University Faculty of Medicine, Department of Pediatric Oncology, Mersin, Turkey,* Address for Correspondence: Mersin University Faculty of Medicine, Department of Pediatric Oncology, Mersin, Turkey E-mail:
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Abstract
The increased incidence and prevalence of neuroendocrine tumors (NETs) over the past few decades has been accompanied by an improvement in overall survival. There are differences in the management of small bowel NETs versus pNETs. The management of all patients with NETs must be individualized based on patient characteristics as well tumor-related factors. This article reviews the role of somatostatin analogues, historical results with chemotherapy in gastroenteropancreatic NETs (GEPNETs), and more recent evidence for the use of cytotoxic chemotherapy in GEPNETs. The article also discusses molecular targeted therapies approved for use in GEPNETs and some ongoing clinical trials.
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Affiliation(s)
- Chandrikha Chandrasekharan
- Division of Medical Oncology, University of Iowa, 200 Hawkins Drive, C GH 32, Iowa City, Iowa 52242, USA.
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Falhammar H, Stenman A, Calissendorff J, Juhlin CC. Presentation, Treatment, Histology, and Outcomes in Adrenal Medullary Hyperplasia Compared With Pheochromocytoma. J Endocr Soc 2019; 3:1518-1530. [PMID: 31384714 PMCID: PMC6676072 DOI: 10.1210/js.2019-00200] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 06/05/2019] [Indexed: 12/18/2022] Open
Abstract
Context Information about adrenal medullary hyperplasia (AMH) is scarce. Objective To study a large cohort of AMHs. Design Setting and Participants Nineteen AMH cases were compared with 95 pheochromocytomas (PCCs) without AMH. AMH without (n = 7) and with PCC (n = 12) were analyzed separately. Results Of 936 adrenalectomies, 2.1% had AMH. Mean age was 47.2 ± 15.1 years. Only two (11%) AMHs had no concurrent PCC or adrenocortical adenoma. In AMHs, a genetic syndrome was present in 58% vs 4% in PCCs (P < 0.001). The noradrenaline/metanephrine levels were lower in AMHs, whereas suppression of dexamethasone was less than in PCCs. Cushing syndrome was found in 11% of AMHs. More AMHs were found during screening and less as incidentalomas. PCC symptoms were less prevalent in AMHs. Surgical management was similar; however, fewer of the AMHs were pretreated with alpha-blockers. Adrenalectomy improved blood pressure slightly less in AMHs. The disappearance of glycemic disturbances was similar to the PPCs. During a period of 11.2 ± 9.4 years, a new PCC developed in 32% of patients with AMH, 11% died, but no PCC metastasis occurred (PCCs: 4%, P < 0.001; 14% and 5%). AMHs without PCC had milder symptoms but more often Cushing disease than patients with PCC, whereas AMH with PCC more often displayed a familiar syndrome with more PCC recurrences. Conclusion A total of 2.1% of all adrenalectomies displayed AMH. AMH seemed to be a PCC precursor. The symptoms and signs were milder than PCCs. AMHs were mainly found due to screening. Outcomes seemed favorable, but new PCCs developed in many during follow-up.
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Affiliation(s)
- Henrik Falhammar
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Adam Stenman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Breast, Endocrine Tumours and Sarcoma, Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Jan Calissendorff
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Carl Christofer Juhlin
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
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van Lierop ZY, Jentjens S, Anten MH, Wierts R, Stumpel CT, Havekes B, van Kroonenburgh MJ. Thyroid Gland 18F-FDG Uptake in Neurofibromatosis Type 1. Eur Thyroid J 2018; 7:155-161. [PMID: 30023349 PMCID: PMC6047496 DOI: 10.1159/000488706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/19/2018] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To investigate thyroid gland characteristics on 18F-FDG positron emission tomography/computed tomography (PET/CT) imaging in patients with neurofibromatosis type 1 (NF1). SUBJECTS AND METHODS Thyroid gland characteristics of patients with a clinical diagnosis of NF1 who underwent 18F-FDG PET/CT imaging for the first time to distinguish benign neurofibroma from malignant peripheral nerve sheath tumor (MPNST) at our institution (n = 69) were compared to PET/CT imaging of sarcoidosis (n = 25) and early stage lung cancer (T1N0M0 tumors, n = 15) patients. RESULTS Two NF1 patients (3%) showed a diffuse 18F-FDG uptake in the thyroid gland, 2 patients (3%) had an irregular uptake, and 7 patients (10%) had a focal uptake. Among the sarcoidosis patients, 1 showed a diffuse uptake (4%) and 1 had an irregular uptake (4%). In the early stage lung cancer group, 1 patient showed a diffuse uptake (7%) and 1 had a focal uptake (7%). NF1 patients had larger mean thyroid volume and mean SUVmax compared to sarcoidosis patients but not compared to early stage lung cancer patients. Four NF1 patients were diagnosed with multinodular goiter, 2 patients were diagnosed with benign chronic lymphocytic thyroiditis, 1 patient had metastasis to the thyroid, and 1 patient had medullary thyroid cancer. CONCLUSION Even though NF1 patients did not show an increased risk of thyroid incidentaloma on PET/CT compared to previous studies on non-thyroid cancer patients, the incidence shows that awareness of possible thyroid disease is important.
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Affiliation(s)
- Zoë Y.G.J. van Lierop
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
- **Zoë Y.G.J. van Lierop, MD, Department of Neurology, Maastricht University Medical Centre, PO Box 5800, NL-6202 AZ Maastricht (The Netherlands), E-Mail
| | - Sander Jentjens
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Monique H.M.E. Anten
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Neurofibromatosis Expert Team, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Roel Wierts
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Connie T. Stumpel
- Neurofibromatosis Expert Team, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Bas Havekes
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marinus J.P.G. van Kroonenburgh
- Neurofibromatosis Expert Team, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- *Marinus J.P.G. van Kroonenburgh, MD, PhD, Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, PO Box 5800, NL-6202 AZ Maastricht (The Netherlands), E-Mail
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Liu IH, Kunz PL. Biologics in gastrointestinal and pancreatic neuroendocrine tumors. J Gastrointest Oncol 2017; 8:457-465. [PMID: 28736633 PMCID: PMC5506272 DOI: 10.21037/jgo.2016.12.09] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 10/04/2016] [Indexed: 12/19/2022] Open
Abstract
The development of biologic agents has ushered in a new era of precision medicine, opening the door to new therapeutic options designed to intelligently target cancer cells and their promoting factors, while leaving normal cells relatively unharmed. Biologics for the treatment of neuroendocrine tumors (NETs) have followed in the footsteps of regimens targeting pathways upregulated in other cancers, including the vascular endothelial growth factor (VEGF) and the mammalian target of rapamycin (mTOR). Through a number of clinical trials, the mTOR inhibitor everolimus and the receptor tyrosine kinase (RTK) inhibitor sunitinib were recently approved for NETs. Other biologics such as the VEGF-A inhibitor bevacizumab have also demonstrated promising clinical activity in NETs. Interestingly, though trials have demonstrated the efficacy of everolimus and sunitinib in extending progression-free survival (PFS) in NETs, objective response rates (RR) are uniformly low, indicating that the primary effect of these drugs is maintenance of stable disease. Due to the relatively indolent nature of the more common, well-differentiated variety of NETs, stable disease is often a reasonable goal for NET patients. Well-differentiated NETs have been shown to be poor responders to cytotoxic chemotherapy, underlining the important role of biologics in treating and managing NETs and their hormonal symptoms. Ongoing and future trials are investigating a wide variety of biologic compounds in NETs, including other RTK inhibitors, mTOR pathway inhibitors, and immune checkpoint inhibitors. Within this review, we will discuss major trials leading up to the FDA approval of everolimus and sunitinib for NETs, as well as other promising biologics currently under investigation in NET clinical trials.
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Affiliation(s)
- Iris H Liu
- Stanford University School of Medicine, Stanford, CA, USA
| | - Pamela L Kunz
- Stanford University School of Medicine, Stanford, CA, USA
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Abstract
Pancreatic neuroendocrine tumors are rare and the majority of patients present in the advanced stage. Over the past few decades, treatment for patients with metastatic well- or moderately differentiated pancreatic neuroendocrine tumors have not significantly impeded tumor progression nor improved survival. However, recent mapping of intracellular signaling pathways promoting tumor proliferation, growth, and angiogenesis has presented mammalian target of rapamycin (mTOR) as a potential target within the phosphatidylinositol 3-kinase-Akt pathway. With the development of the new-generation mTOR inhibitor everolimus, a series of clinical trials over the last 5 years have demonstrated significant benefit in delaying tumor progression. This review focuses on the mechanism of mTOR inhibition and traces the development of clinical evidence for the use of mTOR inhibitors in well- to moderately differentiated advanced pancreatic neuroendocrine tumors.
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Yao JC, Phan AT, Chang DZ, Wolff RA, Hess K, Gupta S, Jacobs C, Mares JE, Landgraf AN, Rashid A, Meric-Bernstam F. Efficacy of RAD001 (everolimus) and octreotide LAR in advanced low- to intermediate-grade neuroendocrine tumors: results of a phase II study. J Clin Oncol 2008; 26:4311-8. [PMID: 18779618 PMCID: PMC2653122 DOI: 10.1200/jco.2008.16.7858] [Citation(s) in RCA: 456] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Evaluate the activity of everolimus (RAD001) in combination with octreotide long-acting repeatable (LAR) in patients with advanced low- to intermediate-grade neuroendocrine tumors. METHODS Treatment consisted of RAD001 5 mg/d (30 patients) or 10 mg/d (30 patients) and octreotide LAR 30 mg every 28 days. Thirty carcinoid and 30 islet cell patients were enrolled. RESULTS Intent-to-treat response rate was 20%. Per protocol, there were 13 with partial responses (22%), 42 with stable disease (SD; 70%), and five patients with progressive disease (8%). Overall median progression-free survival (PFS) was 60 weeks. Median PFS for patients with known SD at entry was longer than for those who had progressive disease (74 v 50 weeks; P < .01). Median overall survival has not been reached. One-, 2-, and 3-year survival rates were 83%, 81%, and 78%, respectively. Among 37 patients with elevated chromogranin A, 26 (70%) achieved normalization or more than 50% reduction. Most common toxicity was mild aphthous ulceration. Grade 3/4 toxicities occurring in >or= 10% of patients included hypophosphatemia (11%), fatigue (11%), and diarrhea (11%). Treatment was associated with a dose-dependent rise in lactate dehydrogenase (LDH). Those with lower than 109 U/L rise in LDH at week 4 had shorter PFS (38 v 69 weeks; P = .01). Treatment was also associated with a decrease in proliferation marker Ki-67 among patients who underwent optional paired pre- and post-treatment biopsy (P = .04). CONCLUSION RAD001 at 5 or 10 mg/d was well tolerated in combination with octreotide LAR, with promising antitumor activity. Confirmatory studies are ongoing.
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Affiliation(s)
- James C. Yao
- From the Departments of Gastrointestinal Medical Oncology, Biostatistics, Radiology, Pathology, and Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Alexandria T. Phan
- From the Departments of Gastrointestinal Medical Oncology, Biostatistics, Radiology, Pathology, and Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - David Z. Chang
- From the Departments of Gastrointestinal Medical Oncology, Biostatistics, Radiology, Pathology, and Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Robert A. Wolff
- From the Departments of Gastrointestinal Medical Oncology, Biostatistics, Radiology, Pathology, and Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Kenneth Hess
- From the Departments of Gastrointestinal Medical Oncology, Biostatistics, Radiology, Pathology, and Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Sanjay Gupta
- From the Departments of Gastrointestinal Medical Oncology, Biostatistics, Radiology, Pathology, and Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Carmen Jacobs
- From the Departments of Gastrointestinal Medical Oncology, Biostatistics, Radiology, Pathology, and Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Jeannette E. Mares
- From the Departments of Gastrointestinal Medical Oncology, Biostatistics, Radiology, Pathology, and Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Andrea N. Landgraf
- From the Departments of Gastrointestinal Medical Oncology, Biostatistics, Radiology, Pathology, and Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Asif Rashid
- From the Departments of Gastrointestinal Medical Oncology, Biostatistics, Radiology, Pathology, and Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Funda Meric-Bernstam
- From the Departments of Gastrointestinal Medical Oncology, Biostatistics, Radiology, Pathology, and Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
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Yao JC, Eisner MP, Leary C, Dagohoy C, Phan A, Rashid A, Hassan M, Evans DB. Population-based study of islet cell carcinoma. Ann Surg Oncol 2007; 14:3492-500. [PMID: 17896148 PMCID: PMC2077912 DOI: 10.1245/s10434-007-9566-6] [Citation(s) in RCA: 225] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2007] [Revised: 06/18/2007] [Accepted: 06/24/2007] [Indexed: 12/17/2022]
Abstract
BACKGROUND We examine the epidemiology, natural history, and prognostic factors that affect the duration of survival for islet cell carcinoma by using population-based registries. METHODS The Surveillance, Epidemiology, and End Results (SEER) Program database (1973-2003 release, April 2006) was used to identify cases of islet cell carcinoma by histology codes and tumor site. RESULTS A total of 1310 (619 women and 691 men) cases with a median age of 59 years were identified. The annual age-adjusted incidence in the periods covered by SEER 9 (1973-1991), SEER 13 (1992-1999), and SEER 17 (2000-2003) were .16, .14, and .12 per 100,000, respectively. The estimated 28-year limited duration prevalence on January 1, 2003, in the United States was 2705 cases. Classified by SEER stage, localized, regional, and distant stages corresponded to 14%, 23%, and 54% of cases. The median survival was 38 months. By stage, median survival for patients with localized, regional, and distant disease were 124 (95% CI, 80-168) months, 70 (95% CI, 54-86) months, and 23 (95% CI, 20-26) months, respectively. By multivariate Cox proportional modeling, stage (P < .001), primary tumor location (P = .04), and age at diagnosis (P < .001) were found to be significant predictors of survival. CONCLUSIONS Islet cell carcinomas account for approximately 1.3% of cancers arising in the pancreas. Most patients have advanced disease at the time of diagnosis. Despite the disease's reputation of being indolent, survival of patients with advanced disease remains only 2 years. Development of novel therapeutic approaches is needed.
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Affiliation(s)
- James C Yao
- Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA.
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Kainuma O, Ito Y, Taniguchi T, Shimizu T, Nakada H, Date Y, Hara T. Ampullary somatostatinoma in a patient with von Recklinghausen's disease. J Gastroenterol 1996; 31:460-4. [PMID: 8726843 DOI: 10.1007/bf02355041] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We report a case of somatostatinoma of the ampulla of Vater associated with von Recklinghausen's disease in a 44-year-old woman. On admission the patient was jaundiced, and percutaneous Cholangio-drainage was performed. Cholangiography revealed stenosis of the common bile duct at the lower end Duodenoscopy showed a yellowish tumor of the ampulla of Vater, and the biopsy specimens showed no malignant cells. Pylorus-preserving pancreaticoduo-denectomy was performed. Histologically, the tumor was composed of small round cells with a solid or trabecular pattern and with multiple psammoma bodies. Immunohistochemical examination showed that the tumor cells stained for somatostatin. Genomic examination showed neither K-ras nor p53 gene mutations of the resected specimen.
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Affiliation(s)
- O Kainuma
- Department of Surgery, Shimizu Kosei Hospital, Japan
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Abstract
A 45-year-old man with neurofibromatosis presented with recurrent seizures due to hypoglycaemia caused by an insulinoma. The attacks were abolished after the successful removal of the insulinoma. This probably represents another example of the association between neurofibromatosis and a tumour consisting of cells with amine-precursor-uptake and decarboxylation.
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Affiliation(s)
- J W Fung
- Department of Medicine, University of Hong Kong, Queen Mary Hospital
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