1. Interesting Case Presentation Neuroendocrine Lung Tumors M. Demiri B Oncology Clinic Director Saint Savvas Anticancer Hospital

2. Male patient, 40 years old No previous medical history 6 ος /2009: hemoptysis, imaging shows a left lower pulmonary lobe mass. Patient was subjected to a left lower lobectomy.

3. Pathology Report: neuroendocrine neoplasm; atypical carcinoid (AC) [mild cellular pleomorphism, necrosis, 3 mitoses/2 mm 2, chromogranin +, NSE +, CD 56 +, CK8/18+]

4. 6/2009 up to 7/2012: follow up

5. 7 /2012: scheduled upper abdomen MRI: at least 22 new lesions with a maximum diameter about 1.5 cm in the left, right and caudate liver lobe, with abnormal signal intensity and contrast agent uptake.

6. 10/2012: patient was admitted to the clinic for diagnostic workout and further treatment planning. – NSE, CA19-9, CEA, urine-5-HIAA: normal – Chromogranin: 108 ng/ml (normal values: in serum 10- 110, in plasma 18-150) Due to their small size the liver lesions could not be biopsied under CT scan and a laparoscopic liver biopsy could not be done 11/2012: Octreoscan: diffuse abnormal uptake of the radioactive substance in the liver, which shows hyperexpression of somatostatin receptors, primarily sst 2

7. 11/2012: starts 1 st line chemotherapy with CDDP 80 mg/m 2 and Vepesid 100 mg/m 2

8. 1/2013: 3 rd chemotherapy cycle, good tolerance, CT scan restaging: SD 4 th cycle: exertional dyspnea. Heart U/S: marginally normal dimensions of the heart chambers and E.F. 60%. Strict fluid equilibrium control was advised as well as cardiology follow up before chemotherapy. CDDP was changed with CarboAUC5 from the 5 th cycle.

9. 4/2013: completion of 1 st line chemotherapy Restaging: PD with increase in the dimensions of most of the lesions which are noted in all the hepatic lobes, while one left lobe lesion presents a significant enlargement(4 cm from 1.5 cm)

11. 5/2013: starts 2 nd line chemotherapy with Xeloda- Temodal

12. 9/2013: restaging: hepatic lesions remaining, with increase of the dimensions in certain and a decrease in others. Greater enlargement of the left lobe lesion (6 cm from 4 cm)

14. 11/2013: restaging: SD 02/2014: restaging: mild increase of the dimensions in most lesions

16. 04/2014: SD

18. Other therapeutic options are – Everolimus + Somatostatin analog – Lu-Dotatate – LUNA trial (pasireotide)

19. Thank you for your attention.