A multidisciplinary approach to the work up and management of pulmonary carcinoid tumors and DIPNECH: a narrative review

Ramirez, Robert A.; Cass, Amanda S; Das, Satya; Low, See Wei; Mehrad, Mitra; Rickman, Otis B.; Scherer, Philip M.; Thomas, Katharine; Gillaspie, Erin A.

doi:10.21037/tlcr-22-415

Cited by 14 publications

(3 citation statements)

References 123 publications

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“…In the near future, we will observe a radical change in the management of cancer patients, including LC patients, with the introduction of a multidisciplinary approach to treatments and the development of tailored therapies [273,274]. Cancer will be managed in a more holistic way, taking into account that the tumor develops within a complexity of interactions happening within the human host, such as with the immune system and the gut/lung microbiota.…”

Section: Microbiota Modulation In Lung Cancermentioning

confidence: 99%

Clinical Relevance of Targeted Therapy and Immune-Checkpoint Inhibition in Lung Cancer

et al. 2023

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Lung cancer (LC) represents the second most diagnosed tumor and the malignancy with the highest mortality rate. In recent years, tremendous progress has been made in the treatment of this tumor thanks to the discovery, testing, and clinical approval of novel therapeutic approaches. Firstly, targeted therapies aimed at inhibiting specific mutated tyrosine kinases or downstream factors were approved in clinical practice. Secondly, immunotherapy inducing the reactivation of the immune system to efficiently eliminate LC cells has been approved. This review describes in depth both current and ongoing clinical studies, which allowed the approval of targeted therapies and immune-checkpoint inhibitors as standard of care for LC. Moreover, the present advantages and pitfalls of new therapeutic approaches will be discussed. Finally, the acquired importance of human microbiota as a novel source of LC biomarkers, as well as therapeutic targets to improve the efficacy of available therapies, was analyzed. Therapy against LC is increasingly becoming holistic, taking into consideration not only the genetic landscape of the tumor, but also the immune background and other individual variables, such as patient-specific gut microbial composition. On these bases, in the future, the research milestones reached will allow clinicians to treat LC patients with tailored approaches.

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Section: Microbiota Modulation In Lung Cancermentioning

confidence: 99%

Clinical Relevance of Targeted Therapy and Immune-Checkpoint Inhibition in Lung Cancer

et al. 2023

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“…Lung cancer is the most common type of cancer and one of the leading causes of cancer death. Apart from lung cancer subtypes, carcinoid tumors from neuroendocrine tumors (NET) located in the thorax are relatively slow-growing tumors with fine contours and good prognosis [1]. Lung carcinoid tumors constitute 20% of lung carcinomas and their incidence has increased in recent decades with the development of imaging methods that provide early diagnosis.…”

mentioning

confidence: 99%

“…They are malignant tumors originating from mature cells of the pulmonary diffuse neuroendocrine system, showing neuroendocrine morphology and differentiation. These tumors, which have distinctive clinicopathological features, are classified as low grade typical carcinoid tumors and intermediate grade ones as atypical carcinoid (AC) tumors [1]. Carcinoid…”

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confidence: 99%

Diagnostic and clinical value of F-18 FDG PET/CT in thoracic carcinoid tumors

Aras,

Tulay

2023

j-ebr

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To assess the correlation between standard uptake values (SUVmax, SUVmean) and Ki-67 in typical lung carcinoid (TC) tumors. Methods: Thirty-eight patients with thoracic masses sent for diagnosis and staging were included in the study. F-18 FDG PET / CT was applied to all patients before the operation. The patients were operated by thoracic surgery clinic. By determining different cut-off values (2.5 and 0.5), SUVmean and SUVmax values of the lesions from the curves drawn to the area of interest were calculated. Results: Thirty-eight patients were included in the study (18 women, 20 men). The average age of our patients was 45. Pathological diagnoses of all patients were determined as typical carcinoids. Eight of our patients had parenchymal lesions and twenty of them had endobronchial lesions. The average of the Ki-67 index was about 3-4% (range 1-10%). No recurrence or death was detected after resection in the 5-year follow-up period. SUVmean1 and SUVmean2 values were statistically significant when compared with SUVmax1 and SUVmax2 values (p <0.05). Conclusion:We think that the SUVmean and Ki-67 index may be an important prognostic indicator that identifies high-risk subgroups. It is thought that Ki-67 indices may correlate well with SUVmean values, and low cut-off values may be more suitable for diagnosis and prognosis in typical carcinoid tumors. SUVmean values can be used for lung carcinoid tumors and F-18 FDG PET/CT imaging is useful in the approach to carcinoid tumors of the lung before thoracic surgery.

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The Driver Role of Pathologists in Endocrine Oncology: What Clinicians Seek in Pathology Reports

et al. 2023

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Endocrine neoplasia represents an increasingly broad spectrum of disorders. Endocrine neoplasms range from incidental findings to potentially lethal malignancies. In this paper, we cover the impact of pathology in the interpretation of the clinic-pathological, genetic, and radiographic features underpinning these neoplasms. We highlight the critical role of multidisciplinary interactions in structuring a rational diagnostic and efficient therapeutic plan and emphasize the role of histopathological input in decision-making. In this context, standardized pathology reporting and second opinion endocrine pathology review represent relevant tools to improve the overall diagnostic workup of patients affected by endocrine tumors in every specific scenario. In fact, although a relevant proportion of cases may be correctly identified based on clinical presentation and biochemical/imaging investigations, a subset of cases presents with atypical findings that may lead to an inappropriate diagnosis and treatment plan based on a wrong pathological diagnosis if all pieces of the puzzle are not correctly considered. Pathologists have a responsibility to actively guide clinicians before and during surgical procedures to prevent unnecessary interventions. In all areas of endocrine pathology, pathologists must understand the complexity of tissue preservation and assay sensitivities and specificities to ensure the optimal quality and interpretation of diagnostic material. Finally, pathologists are central actors in tumor tissue biobanking, which is an expanding field in oncology that should be promoted while adhering to strict ethical and methodological standards.

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A multidisciplinary approach to the work up and management of pulmonary carcinoid tumors and DIPNECH: a narrative review

Cited by 14 publications

References 123 publications

Clinical Relevance of Targeted Therapy and Immune-Checkpoint Inhibition in Lung Cancer

Clinical Relevance of Targeted Therapy and Immune-Checkpoint Inhibition in Lung Cancer

Diagnostic and clinical value of F-18 FDG PET/CT in thoracic carcinoid tumors

The Driver Role of Pathologists in Endocrine Oncology: What Clinicians Seek in Pathology Reports

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