TITLE

ACTUAL TRENDS IN DIAGNOSIS AND THERAPY OF NEUROENDOCRINE TUMORS

AUTHOR(S)
Pacak, K.
PUB. DATE
September 2012
SOURCE
Czecho-Slovak Pediatrics / Cesko-Slovenska Pediatrie;2012, Vol. 67 Issue 5, p312
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Neuroendocrine tumors differ from other tumors in that that they use specific pathways to synthesize, store, and release hormones, their metabolites, or precursors; these tumors may differentially express specific receptors or transporters located in either the cell membrane or intracellular space. Additionally, they can uptake released hormones back into their cells converting them into their metabolites. These characteristics allow for the existence of several neuroendocrine, tumor-specific biomarkers (e.g. chromogranin A, metanephrines, serotonin, calcitonin) that can be used to diagnose these tumors. These markers can also be used to monitor progression, recurrence, and/or therapeutic responses to various treatment modalities. Whereas anatomical imaging modalities may well define the size, shape, and structure of tumors, they lack the ability to explore their functional characteristics. Various functional imaging methods exist, of which positron emission tomography (PET) is becoming most popular, in part due to its use in a clinical as well as experimental procedures. One of the advantages of PET scanning is the ability to measure tumor characteristics „in vivo, including such processes as glucose and energy metabolism, DNA and protein synthesis, angiogenesis, apoptosis, and blood flow, among others. Thus, PET in endocrine oncology provides specific tumor detection („in vivo" histology); identifies of specific tumor function and targets for therapy; predicts and assesses responses to therapy regardless of size changes ("early" tumor response); determines the prognosis even before metastatic lesions occur; and eliminates unnecessary treatments, if, for example, a target molecule is not found. The use of PET/CT has dramatically improved detection, localization, and characterization of various tumors, including (neuro)endocrine ones. The emerging technology of PET coupled with MRI is currently available at NIH and it is expected to improve the localization of these tumors. The most updated use of diagnostic markers as well as functional imaging in the evaluation of neuroendocrine tumors and clinical approaches on how to use them for optimal tumor assessment will be presented. Currently there are new options related to treatment of these tumors. As an important part of drug discovery, the use of drug repurposing or repositioning has been rapidly growing in the last few years for the implementation of new therapeutic options for cancer and will be used to accelerate the search for drugs that can be most beneficial to our patients. HIFalpha or PI3K/AKT/mTOR pathways are new promising approaches to neuroendocrine tumors. Approaches to individualized medicine to „se-cure" the optimal therapeutic plan, will also be outlined.
ACCESSION #
88012061

 

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