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

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Presentation on theme: "GI-NEUROENDOCRINE TUMORS THERAPEUTIC APROACHES Chemotherapy: older and recent schemes Ilias Athanasiadis, MD Medical Oncologist Director of the Oncology."— Presentation transcript:

1 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

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27 First ‐ line chemotherapy with capecitabine and temozolomide in patients with metastatic pancreatic endocrine carcinomas Cancer Volume 117, Issue 2, pages 268-275, 7 SEP 2010 DOI: 10.1002/cncr.25425 http://onlinelibrary.wiley.com/doi/10.1002/cncr.25425/full#fig2 Volume 117, Issue 2, http://onlinelibrary.wiley.com/doi/10.1002/cncr.25425/full#fig2

28 First ‐ line chemotherapy with capecitabine and temozolomide in patients with metastatic pancreatic endocrine carcinomas Cancer Volume 117, Issue 2, pages 268-275, 7 SEP 2010 DOI: 10.1002/cncr.25425 http://onlinelibrary.wiley.com/doi/10.1002/cncr.25425/full#fig3 Volume 117, Issue 2, http://onlinelibrary.wiley.com/doi/10.1002/cncr.25425/full#fig3

29 First ‐ line chemotherapy with capecitabine and temozolomide in patients with metastatic pancreatic endocrine carcinomas Cancer Volume 117, Issue 2, pages 268-275, 7 SEP 2010 DOI: 10.1002/cncr.25425 http://onlinelibrary.wiley.com/doi/10.1002/cncr.25425/full#fig4 Volume 117, Issue 2, http://onlinelibrary.wiley.com/doi/10.1002/cncr.25425/full#fig4

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33 Representative MGMT staining in carcinoid and pancreatic neuroendocrine tumors. Kulke M H et al. Clin Cancer Res 2009;15:338-345 ©2009 by American Association for Cancer Research

34 PFS and OS for carcinoid and pancreatic neuroendocrine tumor patients treated with temozolomide-based therapy. Kulke M H et al. Clin Cancer Res 2009;15:338-345 ©2009 by American Association for Cancer Research

35 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;15:338-345 ©2009 by American Association for Cancer Research

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

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

39 Figure 1 Cell 2011 144, 646-674DOI: (10.1016/j.cell.2011.02.013) Copyright © 2011 Elsevier Inc. Terms and Conditions Terms and Conditions

40 Figure 3 Cell 2011 144, 646-674DOI: (10.1016/j.cell.2011.02.013) Copyright © 2011 Elsevier Inc. Terms and Conditions Terms and Conditions

41 Figure 6 Cell 2011 144, 646-674DOI: (10.1016/j.cell.2011.02.013) Copyright © 2011 Elsevier Inc. Terms and Conditions Terms and Conditions

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47 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

48 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

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