Thoracic Neuroendocrine Tumours Denis Talbot Professor of Cancer Medicine, University of Oxford 3 rd ESO-ESMO-RCE Clinical Update on Rare Adult Solid Cancers Milan, 1 st –3 rd December 2018 Do not duplicate or distribute without permission from author and ESO
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Thoracic Neuroendocrine Tumours
Denis Talbot
Professor of Cancer Medicine, University of Oxford
3rd ESO-ESMO-RCE Clinical Update on Rare Adult Solid Cancers
Milan, 1st – 3rd December 2018Do not duplicate or d
istribute without
permiss
ion from author a
nd ESO
Goals of the Session
Presentation and Diagnosis
• Demographics
• Pathology
• Clinical Features
• Imaging and Staging
Management
• Surgery
• Somatostatin Analogues
• Peptide Receptor Radiotherapy
• Cytotoxic chemotherapy
• mTOR inhibitors
• Symptom management
• Future Horizons
Denis Talbot ESO 2018
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istribute without
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ion from author a
nd ESO
Incidence
Yao, J. Clin. Oncol, (2008)
Incidence of all malignant neoplasmsIncidence of NETs
Denis Talbot ESO 2018
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25%
16%
13%11%
9%
7%
6%
5%4% 4%
Primary Sites
Pulmonary Small Intestine Appendix Pancreas Skin
Colon/Caecum Stomach Rectum Bladder Oesophagus
Incidence of NETs, 2013-2015
Source: Public Health England
Number of Cases15,434
Age Standardized Incidence Rate8.7 per 100,000 per year (95% CI 8.6-8.8)
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Survival of Pulmonary NET and Lung Cancer diagnosed 2013-2015
Survival 5yr 10yrTC >90% >90%AC 70% 50%
LCNEC 15% 7%
SCLCC 3% 1%
Denis Talbot ESO 2018 Source: Public Health England
Diffuse Idiopathic Pulmonary Neuroendocrine Cell HyperplasiaHistology• Linear proliferation of scattered NE cells (pre-malignant)• Usually confined to bronchial epithelium• May extend beyond basement membrane to form Tumourlets
Clinical Features• F:M 10:1• Median age at presentation 58y• Not associated with smoking• Asymptomatic or symptoms of airflow obstructionDo not duplica
Left lower lobe Typical Carcinoid Tumour resected 1 year previously68Ga-DOTATATE PET/CT: local recurrence near surgical clips, regional sub-cm nodes and bony metastases
Courtesy of Michael HofmanPeter MacCallum Cancer Centre
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istribute without
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ion from author a
nd ESO
Denis Talbot ESO 2018
Treatment
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istribute without
permiss
ion from author a
nd ESO
1970’s 1980’s 1990’s 2011 2015 2016 2017
Therapies for NETs: Historical PerspectiveFDA/EMA Approved
Not FDA/EMA Approved
STZ in pNET
Octreotide, IFN inCarcinoid Syndrome
Lanreotidein GEP NETS
Telotristat inrefractory
CS diarrhoea
Liver-directed:TACE/TAE/TARE
Pasireotide
Oxaliplatin
Octreotidein mid gut NETs
PRRT in GEP NET
Everolimus in non functioning NETs
Sunitinib, Everolimusin pNET
Lanreotide inCarcinoid Syndrome
Bevacizumab
Etoposide/ PtSCLC
Cytotoxic Agents
Treatment of CS
Signaling Pathways
Radiation / Physical
SSA as anti-tumour agentsDo not duplica
te or distr
ibute without
permiss
ion from author a
nd ESO
1970’s 1980’s 1990’s 2011 2015 2016 2017
Therapies for NETs: Historical PerspectiveFDA/EMA Approved