Treatment for Neuroendocrine Tumors Needs Improvement

Rush University Medical Center recently announced a novel functional imaging test for patients with neuroendocrine tumors, in addition to other initiatives to improve treatment.

Since the tumors can be small, they can be difficult to spot through CT or MRI scans, and presents a challenge to physicians. The medical center will be offering the test using the 68 Gallium DOTATATE PET/CT scanner that recently received FDA approval, according to a press release.

The neuroendocrine system is notoriously complex, since it is located throughout the body rather than 1 location. Neuroendocrine cells release hormones that regulate numerous biological processes.

The tumors can grow in many places throughout the body, including the pancreas, adrenal glands, gastrointestinal tract, lungs, and brain, according to the release. Treatment strategies and patient outcomes can depend on where the tumor originated and its stage.

Early-stage tumors can be cured through surgery, but surgeons need to know the exact location of the cancer. However, the tumors can be extremely difficult to detect with traditional imaging methods.

“Unfortunately, in about half of the patients, these tumors have metastasized at the time of diagnosis, meaning they have spread out of their primary location where they originated,” said Xavier M. Keutgen, MD, director of surgical services with the Rush Neuroendocrine Tumor Program.

For the DOTATATE test, patients are injected with radioactive dye that binds with neuroendocrine tumors, no matter the size, according to the release. Studies show that this imaging approach can be superior at identifying the tumors, compared with an older test.

Results from the novel test can be used to develop an effective treatment plan.

“Let’s say a patient comes to me with a CT scan that shows a neuroendocrine tumor in the small intestine and something questionable on the liver or lungs. In this case, we don't know if the cancer has metastasized or not,” Dr Keutgen said. “By getting a DOTOTATE scan, we will know whether that questionable liver or lung finding is a neuroendocrine tumor deposit. If it is, we can often remove all tumors when we operate and potentially cure the patient. If it isn’t, then we avoid an unnecessary surgery and focus on other non-surgical ways to help the patient.”

Although neuroendocrine tumors are rare, Chicago has 200 to 350 new cases per year, which is why the Illinois-based hospital has adopted the test, according to the release.

“The neuroendocrine tumor world is evolving rapidly, and patients need a place to go that can provide the entire diagnostic and treatment spectrum," Dr Keutgen said. "They need a team of experts who know all the available options and can determine the best approach for a particular patient with a particular type of tumor.”

Once neuroendocrine tumors have metastasized, patients may receive treatment with chemotherapy or other drugs to slow growth, according to the press release.

“Right now, oncologists assign one drug or another just randomly,” Dr Keutgen said. “It’s like flipping a coin. If it doesn't work after 3 or 6 months, then they’ll try another.”

To improve treatments, Rush physicians have partnered with the National Cancer Institute to use genetic tests to determine mutations in the tumors.

“You figure out what the mutation is, and you assign a drug that targets that mutation,” Dr Keutgen said.

In addition to implementing a new testing technique, researchers from Rush will begin a clinical trial where they will test neuroendocrine tumors for genetic mutations. The patients will then be prescribed treatment based on mutations.

Further research will likely improve treatment for neuroendocrine tumors, in addition to genetic testing and new imaging techniques.

“We’re here to assist and support physicians in the community treating these patients,” Dr Keutgen concluded. “A lot of patients with neuroendocrine tumors require several different types of treatments in their lifetime. We can give local physicians insights into what drugs and other treatments will work best and then work together to follow the patient regularly to make sure the treatment is working.”