12/13/2017 1 PANCREATIC NEUROENDOCRINE TUMORS DECEMBER 12, 2017 IF YOU EXPERIENCE TECHNICAL DIFFICULTY DURING THE PRESENTATION: CONTACT WEBEX TECHNICAL SUPPORT DIRECTLY AT: US TOLL FREE: 1-866-779-3239 TOLL ONLY: 1-408-435 -7088 OR SUBMIT A QUESTION TO THE EVENT PRODUCER VIA THE Q&A PANEL Pancreatic Neuroendocrine Tumors Daniel M. Halperin, MD Assistant Professor Gastrointestinal Medical Oncology The University of Texas MD Anderson Cancer Center
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12/13/2017
1
PANCREATIC
NEUROENDOCRINE TUMORS
DECEMBER 12, 2017
IF YOU EXPERIENCE TECHNICAL DIFFICULTY DURING THE
PRESENTATION:
CONTACT WEBEX TECHNICAL SUPPORT DIRECTLY AT:
US TOLL FREE: 1-866-779-3239
TOLL ONLY: 1-408-435 -7088
OR
SUBMIT A QUESTION TO THE EVENT PRODUCER VIA
THE Q&A PANEL
Pancreatic Neuroendocrine TumorsDaniel M. Halperin, MD
Assistant Professor
Gastrointestinal Medical Oncology
The University of Texas MD Anderson Cancer Center
12/13/2017
2
Disclosures• Consultant for Novartis, AbbVie.
• Research funded by Ipsen, Genentech, Novartis, Tarveda, Dicerna (prior).
• I will discuss off-label and/or investigational use.
Disclosures (cont.)• No webinar is a substitute for a personal consultation with a trusted
physician.
12/13/2017
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Overview• Basics of the pancreas and pancreatic neuroendocrine neoplasms (NENs)
• Epidemiology
• Clinical presentations
• Basic biology
• Modern treatment approaches
• Future investigational directions
This is not conventional pancreas cancer
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Pancreas Anatomy/Physiology 101Exocrine
• Acinar cells produce digestive enzymes, delivered to the GI tract by ducts.
Endocrine
• Islet cells secrete hormones into blood.
Bardeesy and DePinho, Nat Rev Cancer. 2002 Dec;2(12):897-909.
Rising Incidence of Pancreatic NETs
Dasari et al., JAMA Oncol. 2017 Oct 1;3(10):1335-1342
Pancreatic
Adenocarcinoma
12.5/100,000
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Rising Prevalence of Pancreatic NETs
Dasari et al., JAMA Oncol. 2017 Oct 1;3(10):1335-1342
NET Framework• NETs arise from endocrine cells distributed
throughout the aerodigestive tract, including the pancreas.
• Classified in four dimensions:
• Primary Site
• Grade
• Stage
• Functional Status (hormonal secretion)
• Frequently express somatostatin receptors
Histology of NET. A: H&E; B: CgA
Halperin and Yao, MD Anderson Manual of Medical Oncology, 3e.
Histology of adenocarcinoma
Hruban and Fukushima, Modern Pathology (2007) 20, S61–S70.
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Grading NENs (2017)Grade
1 NET < 2 mitoses/10 HPF, Ki-67 <3%
2 NET 2-20 mitoses/10 HPF, Ki-67 3-20%
3 NET Well-differentiated
>20 mitoses/10 HPF, Ki-67 >20%
3 NEC Poorly-differentiated
>20 mitoses/10 HPF, Ki-67 >20%
Grade is dependent on appearance and rate of cellular division
Grade, Stage, Primary Site
Yao et al., J Clin Oncol 2008; 26:3063
Primary Tumor
Site
Median Survival
(months)
Appendix NA
Cecum 98
Colon 14
Lung 24
Pancreas 60
Rectum 33
Small Intestine 103
Stomach 29
Dasari et al., JAMA Oncol. 2017 Oct 1;3(10):1335-1342