Stereotactic Ablative Body Radiotherapy Versus Conventionally Fractionated Radiotherapy for early Stage Large Cell Neuroendocrine Carcinoma of the Lung

Wegner, Rodney E.; Abel, Stephen; Colonias, Athanasios

doi:10.2217/lmt-2020-0004

Cited by 4 publications

(2 citation statements)

References 18 publications

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“…One retrospective study of SEER data used propensity-matched analysis to compare stereotactic ablative body radiotherapy (SABR) to conventionally fractionated radiation therapy in patients with early stage pulmonary LCNEC that were not surgical candidates. In this study SABR was associated with improved OS (99).…”

Section: Radiationsupporting

confidence: 49%

Management of Large Cell Neuroendocrine Carcinoma

et al. 2021

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BackgroundLarge cell neuroendocrine carcinoma (LCNEC) is a rare, aggressive cancer with a dismal prognosis. The majority of cases occur in the lung and the gastrointestinal tract; however, it can occur throughout the body. Recently advances in the understanding of the molecular underpinnings of this disease have paved the way for additional novel promising therapies. This review will discuss the current best evidence for management of LCNEC and new directions in the classification and treatment of this rare disease.MethodsWe performed a PubMed search for “Large cell neuroendocrine carcinoma” and “High grade neuroendocrine carcinoma.” All titles were screened for relevance to the management of LCNEC. Papers were included based on relevance to the management of LCNEC.ResultsPapers were included reviewing both pulmonary and extra pulmonary LCNEC. We summarized the data driven best practices for the management of both early and advanced stage LCNEC. We describe emerging therapies with promising potential.DiscussionLCNEC are rare and aggressive neoplasms. In advanced disease, the historical regimen of platinum based therapy in combination with etoposide or irinotecan remains among the commonly used first line therapies, however for extra thoracic LCNEC regimens like FOLFOX, FOLFOIRI and CAPTEM can also be used. Further effective and safe treatment options are desperately needed. Recently, new advances including a new understanding of the genetic subcategories of LCNEC and immunotherapy agents may guide further treatments.

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Section: Radiationsupporting

confidence: 49%

Management of Large Cell Neuroendocrine Carcinoma

et al. 2021

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“…Wegner et al retrospectively compared patients with T1-2 N0 LCNEC not suitable for surgery treated with SBRT or conventional fractionated radiotherapy (CFRT), and the results favored SBRT (median OS of 34.7 versus 23.7 months; p = 0.02) (62). Gu and colleagues demonstrated that patients with stage I-III LCNEC not suitable for surgery achieved a better prognosis with the combination of definitive chemo-radiation than with chemotherapy alone (p = 0.003) (55).…”

Section: Early Stage: Role Of Surgery and Radiotherapymentioning

confidence: 99%

Large Cell Neuro-Endocrine Carcinoma of the Lung: Current Treatment Options and Potential Future Opportunities

et al. 2021

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Large-cell neuroendocrine carcinomas of the lung (LCNECs) are rare tumors representing 1–3% of all primary lung cancers. Patients with LCNEC are predominantly male, older, and heavy smokers. Histologically, these tumors are characterized by large cells with abundant cytoplasm, high mitotic rate, and neuroendocrine immunohistochemistry-detected markers (chromogranin-A, synaptophysin, and CD56). In 2015 the World Health Organization classified LCNEC as a distinct subtype of pulmonary large-cell carcinoma and, therefore, as a subtype of non-small cell lung carcinoma (NSCLC). Because of the small-sized tissue samples and the likeness to other neuroendocrine tumors, the histological diagnosis of LCNEC remains difficult. Clinically, the prognosis of metastatic LCNECs is poor, with high rates of recurrence after surgery alone and overall survival of approximately 35% at 5 years, even for patients with early stage disease that is dramatically shorter compared with other NSCLC subtypes. First-line treatment options have been largely discussed but with limited data based on phase II studies with small sample sizes, and there are no second-line well defined treatments. To date, no standard treatment regimen has been developed, and how to treat LCNEC is still on debate. In the immunotherapy and targeted therapy era, in which NSCLC treatment strategies have been radically reshaped, a few data are available regarding these opportunities in LCNEC. Due to lack of knowledge in this field, many efforts have been done for a deeper understanding of the biological and molecular characteristics of LCNEC. Next generation sequencing analyses have identified subtypes of LCNEC that may be relevant for prognosis and response to therapy, but further studies are needed to better define the clinical impact of these results. Moreover, scarce data exist about PD-L1 expression in LCNEC and its predictive value in this histotype with regard to immunotherapy efficacy. In the literature some cases are reported concerning LCNEC metastatic patients carrying driver mutations, especially EGFR alterations, showing targeted therapy efficacy in this setting of disease. Due to the rarity and the challenging understanding of LCNEC, in this review we aim to summarize the management options currently available for treatment of LCNEC.

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