GI-NEUROENDOCRINE TUMORS THERAPEUTIC APROACHES Chemotherapy: older and recent schemes Ilias Athanasiadis, MD Medical Oncologist Director of the Oncology.

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Presentation transcript:

GI-NEUROENDOCRINE TUMORS THERAPEUTIC APROACHES Chemotherapy: older and recent schemes Ilias Athanasiadis, MD Medical Oncologist Director of the Oncology Department MITERA Hospital, HYGEIA Athens, July 5, 2014

First ‐ line chemotherapy with capecitabine and temozolomide in patients with metastatic pancreatic endocrine carcinomas Cancer Volume 117, Issue 2, pages , 7 SEP 2010 DOI: /cncr Volume 117, Issue 2,

First ‐ line chemotherapy with capecitabine and temozolomide in patients with metastatic pancreatic endocrine carcinomas Cancer Volume 117, Issue 2, pages , 7 SEP 2010 DOI: /cncr Volume 117, Issue 2,

First ‐ line chemotherapy with capecitabine and temozolomide in patients with metastatic pancreatic endocrine carcinomas Cancer Volume 117, Issue 2, pages , 7 SEP 2010 DOI: /cncr Volume 117, Issue 2,

Representative MGMT staining in carcinoid and pancreatic neuroendocrine tumors. Kulke M H et al. Clin Cancer Res 2009;15: ©2009 by American Association for Cancer Research

PFS and OS for carcinoid and pancreatic neuroendocrine tumor patients treated with temozolomide-based therapy. Kulke M H et al. Clin Cancer Res 2009;15: ©2009 by American Association for Cancer Research

PFS and OS in patients with MGMT-intact or MGMT-deficient neuroendocrine tumors treated with temozolomide-based therapy. Kulke M H et al. Clin Cancer Res 2009;15: ©2009 by American Association for Cancer Research

Challenging issues Tumor heterogeneity Tumor evolution and clone selection Adaptation to therapy The importance of the stroma The host immune surveillance and immune tolerance

Following and understanding the tumor evolution Biomarkers as prognostic and predictive markers Circulating tumor cells Next generation sequencing in sequential specimens

Figure 1 Cell , DOI: ( /j.cell ) Copyright © 2011 Elsevier Inc. Terms and Conditions Terms and Conditions

Figure 3 Cell , DOI: ( /j.cell ) Copyright © 2011 Elsevier Inc. Terms and Conditions Terms and Conditions

Figure 6 Cell , DOI: ( /j.cell ) Copyright © 2011 Elsevier Inc. Terms and Conditions Terms and Conditions

Conclusion Chemotherapy is active in advanced pancreatic NETs Alkylating agents has been the main pillar of systemic chemotherapy Streptozotocin application is based on experience and studies from the past, but toxicity is a limitation

Conclusion Temozolomide, capecitabine and combinations with bevacizumab demonstrate promising results challenging the current “standard” Activity in carcinoid tumors is modest Individualization of therapy and biomarkers represent a promising direction